Early prognostic stratification and identification of irreversibly shocked patients despite primary percutaneous coronary intervention. Issue 4 (13th April 2022)

• Record Type: Journal Article
• Authors: Falco, Luca; Fabris, Enrico; Gregorio, Caterina; Pezzato, Andrea; Milo, Marco; Massa, Laura; Lardieri, Gerardina; Korcova, Renata; Cominotto, Franco; Vitrella, Giancarlo; Rakar, Serena; Perkan, Andrea; Sinagra, Gianfranco
• Is Part Of: Journal of cardiovascular medicine. Volume 23:Issue 4(2022)
• Page Start: 247
• Page End: 253
• Publication Date: 2022-04-13
• Subjects: cardiogenic shock -- elderly -- myocardial infarction -- prehospital stratification -- primary percutaneous coronary intervention; Cardiology -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; Cardiology -- Periodicals; Cardiovascular Diseases -- Periodicals; 616.1005
• DOI: 10.2459/JCM.0000000000001282
• Languages: English
• ISSNs: 1558-2027

Abstract

Abstract : Background: Despite prognostic improvements in ST-elevation myocardial infarction (STEMI), patients presenting with cardiogenic shock (CS) have still high mortality. Which are the relevant early prognostic factors despite revascularization in this high-risk population is poorly investigated. Methods: We analyzed STEMI patients treated with primary percutaneous coronary intervention (PCI) and enrolled at the University Hospital of Trieste between 2012 and 2018. A decision tree based on data available at first medical contact (FMC) was built to stratify patients for 30-day mortality. Multivariate analysis was used to explore independent factors associated with 30-day mortality. Results: Among 1222 STEMI patients consecutively enrolled, 7.5% presented with CS. CS compared with no-CS patients had worse 30-day mortality (33% vs 3%, P < 0.01). Considering data available at FMC, CS patients with a combination of age ≥76 years, anterior STEMI and an expected ischemia time > 3 h and 21 min were at the highest mortality risk, with a 30-day mortality of 85.7%. In CS, age (OR 1.246; 95% CI 1.045–1, 141; P = 0.003), final TIMI flow 2–3 (OR 0.058; 95% CI 0.004–0.785; P = 0.032) and Ischemia Time (OR = 1.269; 95% CI 1.001–1.609; P = 0.049) were independently associated with 30-day mortality. Conclusions: In a contemporary real-world population presenting with CS due to STEMI, age is a relevant negative factor whereas an early and successful PCI is positively correlated with survival. However, a subgroup of elderly patients had severe prognosis despite revascularization. Whether pPCI may have an impact on survival in a very limited number of irreversibly critically ill patients remains uncertain and the identification of irreversibly shocked patients remains nowadays challenging.