Cardiogenic shock in the course of myocardial infarction: the results of the Shock-POL registry

Aims Cardiogenic shock (CS) represents an ominous complication of acute myocardial infarction (AMI) with mortality rate exceeding 50%. The aim of the study was to evaluate current management, outcomes and risk factors of mortality of AMI-related CS. Methods This snap-shot registry evaluated all patients with AMI-related CS hospitalized in 9 cardiology centers across Poland between January and December 2023. The inclusion criteria involved CS defined as prolonged (>20 min) hypotension with signs of peripheral hypoperfusion and diagnosis of AMI qualified for urgent coronary angiography. The primary endpoint was in-hospital mortality. Results The study comprised 141 patients (72.3% men; mean age was 69.2 [14] years). The majority of patients were in Society for Cardiovascular Angiography and Interventions class C (n=71,50.4%), followed by class D (n=46,32.6%) and class E (n=24,17.0%). Percutaneous coronary intervention was performed in 133 cases (94.3%) while coronary artery bypass graft in 5 (3.5%). Mechanical circulatory support (MCS) was used in 33 patients (23.4%) and involved intra-aortic balloon pump (n=26,18.4%), Impella CP (n=6,4.3%), Impella 5.5 (n=2,1.4%) and veno-arterial extracorporeal membrane oxygenation (n=10,7.1%). In-hospital mortality rate was 47.5% (n=67), while 30-day mortality was 51.8% (n=73). Cox proportional hazards model showed that non-ST-elevation AMI (HR=2.38,95%CI:1.19-4.75), lack of the need for antibiotic therapy (HR=2.61, 95%CI:1.26-5.39), elevated lactates (unit HR per 1 mmol/l=1.19, 95%CI:1.11-1.27) and age (unit HR=1.05; 95%CI:1.02-1.07) were independent predictors of in-hospital mortality. Conclusions Short-term mortality rate of AMI-related CS still amounts to 50%, which advocates in favor of further research evaluating the true role of MCS in this population.