Short- and Long-Term Mortality Trends in STEMI-Cardiogenic Shock over Three Decades (1989–2018): The Ruti-STEMI-Shock Registry

Abstract

Aims: Cardiogenic shock (CS) is an ominous complication of ST-elevation myocardial infarction (STEMI), despite the recent widespread use of reperfusion and invasive management. The Ruti-STEMI-Shock registry analysed the prevalence of and 30-day and 1-year mortality rates in ST-elevation myocardial infarction (STEMI) complicated by CS (STEMI-CS) over the last three decades. Methods and Results: From February 1989 to December 2018, 493 STEMI-CS patients were consecutively admitted in a well-defined geographical area of ~850,000 inhabitants. Patients were classified into six five-year periods based on their year of admission. STEMI-CS mortality trends were analysed at 30 days and 1 year across the six strata. Cox regression analyses were performed for comparisons. Mean age was 67.5 ± 11.7 years; 69.4% were men. STEMI-CS prevalence did not decline from period 1 to 6 (7.1 vs. 6.2%, p = 0.218). Reperfusion therapy increased from 22.5% in 1989–1993 to 85.4% in 2014–2018. Thirty-day all-cause mortality declined from period 1 to 6 (65% vs. 50.5%, p < 0.001), with a 9% reduction after multivariable adjustment (HR: 0.91; 95% CI: 0.84–0.99; p = 0.024). One-year all-cause mortality declined from period 1 to 6 (67.5% vs. 57.3%, p = 0.001), with an 8% reduction after multivariable adjustment (HR: 0.92; 95% CI: 0.85–0.99; p = 0.030). Short- and long-term mortality trends in patients aged ≥ 75 years remained ~75%. Conclusions: Short- and long-term STEMI-CS-related mortality declined over the last 30 years, to ~50% of all patients. We have failed to achieve any mortality benefit in STEMI-CS patients over 75 years of age.

ST-Segment Elevation Acute Myocardial Infarction Complicated by Cardiogenic Shock: Early Predictors of Very Long-Term Mortality

“…Moreover, although the current clinical guidelines do not recommend routine use of IABP in patients with CS, our study reflects clinical practice during the study enrollment period. Notably, IABP still remains the most commonly used first-line support in this critical setting, as recently reported [ 31 ]. Furthermore, the extent of coronary artery disease and the promptness, completeness, and efficacy of myocardial revascularization were not assessed as confounders.…”

Incidence and predictors of sudden cardiac arrest in the immediate post-percutaneous coronary intervention period for ST-elevation myocardial infarction: a single-center study

“…Cardiogenic shock is not an uncommon complication of STEMI, with incidence ranging from 9 to 14%. It is mainly influenced by the extent of myocardial ischemia and carries a mortality rate of 50-80% [30][31][32][33].…”

Sacubitril/valsartan inhibits obesity-associated diastolic dysfunction through suppression of ventricular-vascular stiffness

“…Diastolic dysfunction (DD), characterized by impaired relaxation of the left ventricle, is one of the early manifestations of heart failure with preserved ejection fraction (HFpEF) [ 31 , 32 ]. Childhood-adolescent overweight and obesity are major health burdens around the globe and the presence of DD has significant impact as a risk factor for the progression of CVD [ 4 , 5 ].…”