Predictors of Hospital Mortality in Patients with Acute Coronary Syndrome Complicated by Cardiogenic Shock

Abstract

As demonstrated by earlier studies, pre-hospital triage with trans-telephonic electrocardiogram (TTECG) and direct referral for catheter therapy shows great value in the management of out-of-hospital chest pain emergencies. It does not only improve in-hospital mortality in ST-segment elevation myocardial infarction, but it has also been identified as an independent predictor of higher in-hospital survival rate. Since TTECG-facilitated triage shortens both transport time and percutaneous coronary intervention (PCI)-related procedural time intervals, it was hypothesized that even high-risk patients with acute coronary syndrome (ACS) and cardiogenic shock (CS) might also benefit from TTECG-based triage. Here, we decided to examine our database for new triage- and left ventricular (LV) function-related parameters that can influence in-hospital mortality in ACS complicated by CS. ACS patients were divided into two groups, namely, (1) hospital death patients (n = 77), and (2) hospital survivors (control, n = 210). Interestingly, TTECG-based consultation and triage of CS and ACS patients were confirmed as significant independent predictors of lower hospital mortality risk (odds ratio (OR) 0.40, confidence interval (CI) 0.21–0.76, p = 0.0049). Regarding LV function and blood chemistry, a good myocardial reperfusion after PCI (high area at risk (AAR) blush score/AAR LV segment number; OR 0.85, CI 0.78–0.98, p = 0.0178) and high glomerular filtration rate (GFR) value at the time of hospital admission (OR 0.97, CI 0.96–0.99, p = 0.0042) were the most crucial independent predictors of a decreased risk of in-hospital mortality in this model. At the same time, a prolonged time interval between symptom onset and hospital admission, successful resuscitation, and higher peak creatine kinase activity were the most important independent predictors for an increased risk of in-hospital mortality. In ACS patients with CS, (1) an early TTECG-based teleconsultation and triage, as well as (2) good myocardial perfusion after PCI and a high GFR value at the time of hospital admission, appear as major independent predictors of a lower in-hospital mortality rate.

Effect of the hospital transfer of STEMI patients through the remote emergency consultation system on the emergency department length of stay and survival at hospital discharge: a single center retrospective cohort study

“…A previous study indicated that an extended interval between symptom onset and hospitalization was the most important independent predictor of an increased risk of in-hospital mortality [21].However, in this study, the symptom onset to ED arrival time, symptom onset to PCI initiation time, categorized time interval from symptom onset to initiation of PCI (≥720 or <720), and the time interval from the ED visit to the initiation of PCI (<30 min, ≥30 min,<60 min, and ≥60 min) did not differ between the No-SHDG and SHDG.…”

“…These results show a tendency for an overall positive correlation between RECS implementation and SHD prediction. A recent study showed that telehealth increased the fatality rate by 13.7% in the non-treated group, compared to 4.1% in an administered group of patients with STEMI during the COVID-19 pandemic [21]. Another study reported that pre-hospital triage with a trans-telephonic electrocardiogram and direct referrals for catheter therapy were independent predictors for improved in-hospital survival and mortality in patients with STEMI [22].…”

Does Albumin Predict the Risk of Mortality in Patients with Cardiogenic Shock?

“…The inclusion of blood-derived biomarkers in risk stratification patients with AMI-related CS may be of major importance since the identification of appropriate risk prediction tools following AMI-related CS remains challenging. Good myocardial reperfusion following PCI and renal function, assessed with glomerular filtration rate (GFR), was recently demonstrated to improve outcomes in AMI-related CS patients [ 33 ]. The prognostic value of the renal function in CS was verified within a sub-study of the CULPRIT-SHOCK study [ 34 ].…”

Diabetes Mellitus Is Still a Strong Predictor of Periprocedural Outcomes of Primary Percutaneous Coronary Interventions in Patients Presenting with ST-Segment Elevation Myocardial Infarction (from the ORPKI Polish National Registry)

“…Therefore, these factors account for the worse long-term prognosis of diabetic patients presenting with STEMI. On the other hand, DM was not identified as an independent predictor of in-hospital mortality in patients with acute coronary syndrome complicated by cardiogenic shock [ 39 ]. More aggressive pharmacotherapy might mitigate these detrimental effects of DM [ 12 , 13 , 14 ].…”