Prognostic Factors of In-Hospital Mortality in Patients with Acute Myocardial Infarction Complicated by Cardiogenic Shock

Abstract

Among patients with acute myocardial infarction (MI) complicated by cardiogenic shock (CS), in-hospital mortality remains high. In the present study, we aimed to identify factors associated with clinical outcomes of acute MI patients with CS in a contemporary setting. A total of 1102 patients with acute MI undergoing primary percutaneous coronary intervention were included, among whom 196 (17.8%) were complicated by CS. The primary outcome was all-cause death during hospitalization, and factors associated with in-hospital mortality were explored in patients with acute MI and CS. Of the 196 patients with acute MI complicated by CS, 77 (39.3%) died during hospitalization. The rates of non-ST-segment elevation MI (NSTEMI) (33.8% vs. 19.3%, p = 0.02) and culprit lesion in the left main or left anterior descending coronary artery (68.8% vs. 47.9%, p = 0.004) were higher, while left ventricular ejection fraction (LVEF) was lower (24.4 ± 11.7% vs. 39.7 ± 13.8%, p < 0.001) in non-survivors than in survivors. Multivariable analysis identified NSTEMI presentation and lower LVEF as independent predictors of in-hospital death. In conclusion, NSTEMI and low LVEF were identified as factors associated with higher in-hospital mortality. The identification of even higher-risk subsets and targeted therapeutic strategies may be warranted to improve survival of patients with acute MI and CS.

Complete revascularization in acute myocardial infarction: a clinical review

“…In a setting of acute MI, 5–10% of patients present with CS, with higher incidence in STEMI compared to NSTEMI [ 51 – 53 ]. CS is a life-threatening condition characterized by systemic hypoperfusion due to primary cardiac dysfunction and an inadequate cardiac output [ 54 ].…”

“…CS is a life-threatening condition characterized by systemic hypoperfusion due to primary cardiac dysfunction and an inadequate cardiac output [ 54 ]. Even in the current era, in-hospital mortality in patients with acute MI remains high at 40–60% when complicated by CS [ 51 – 53 ]. Emergency revascularization with PCI or CABG improves long-term survival in patients with acute MI and CS as shown in the SHOCK trial and is recommended in the guidelines [ 42 , 55 ].…”

Complications and Outcomes of Impella Treatment in Cardiogenic Shock Patients With and Without Acute Myocardial Infarction

“…Some laboratory data potentially related to the outcomes including a lactate level and left ventricular ejection fraction were not available. 18 In the group with non‐AMI‐CS, detailed information in patients with other causes than myocarditis, nonischemic cardiomyopathy, ischemic cardiomyopathy, ventricular arrhythmia, and valvular heart disease was lacking. Because the Impella CP was predominantly used in this study population, analysis on other types of Impella may be underpowered.…”

Differential Impact of Clinical Factors for Predicting High Platelet Reactivity on Clinical Outcomes in Acute Myocardial Infarction Patients Treated With Clopidogrel and Prasugrel

“…This study was a retrospective, bi-center registry study at two tertiary referral hospitals, Chiba University Hospital and affiliated Eastern Chiba Medical Center [14][15][16][17][18][19] . Between January 2012 and March 2020, a total of 1102 patients with acute MI, including ST-segment elevation and non-ST-segment elevation MI, underwent primary PCI procedures at the two centers per local standard practice with a predominant use of radial access, intracoronary imaging, and contemporary drug-eluting stents [20][21][22][23][24] .…”