Key result
Cardiac arrest in STEMI-CS is linked to ~16% higher relative 1-year mortality vs no arrest.
Why the study?
Cardiogenic shock frequently complicates STEMI and may be associated with cardiac arrest, but differences across OHCA, IHCA, and no cardiac arrest were not well characterized.
Does the occurrence of out-of-hospital or in-hospital cardiac arrest worsen survival in patients with STEMI-related cardiogenic shock?
Cohort (n=345)
Yes
Does the occurrence of out-of-hospital or in-hospital cardiac arrest worsen survival in patients with STEMI-related cardiogenic shock?
In STEMI-related cardiogenic shock, concomitant cardiac arrest (OHCA or IHCA) is associated with more complex coronary anatomy and significantly higher 1-year mortality compared to shock without cardiac arrest.
Higher mortality in STEMI-CS with OHCA/IHCA requires realistic prognostic counseling; leaves open whether tailored post-arrest strategies can narrow the survival gap.
Background: Cardiogenic shock (CS) frequently complicates ST-elevation myocardial infarction (STEMI) and may be associated with cardiac arrest occurring either as out-of-hospital (OHCA) or in-hospital cardiac arrest (IHCA).Aim: To compare clinical characteristics, coronary anatomy, management and survival among patients with CS without cardiac arrest (STEMI-CS-no CA), CS with OHCA (STEMI-CS-OHCA) and CS with IHCA (STEMI-CS-IHCA).Methods: We conducted a retrospective study including consecutive patients with CS and STEMI undergoing immediate coronary angiography and percutaneous coronary intervention (PCI) who were admitted to two tertiary university hospitals between 2016 and 2025.Results: Among 345 patients, 150 (43.5%) had STEMI-CS-no CA, 120 (34.8%)STEMI-CS-OHCA, and 75 (21.7%)STEMI-CS-IHCA.STEMI-CS-IHCA patients were older, less frequently presented with an initial shockable rhythm (36.0%vs 61.0%, p=0.002) and had shorter time to return of spontaneous circulation (10.0 vs 19.6 minutes, p<0.001) compared to STEMI-CS-OHCA.They had also lower arterial pressure, left ventricular ejection fraction, estimated glomerular filtration rate and higher arterial lactate compared to STEMI-CS-no CA and STEMI-CS-OHCA.Coronary complexity increased progressively with SYNTAX score rising from 18.6 in STEMI-CSno CA to 21.5 in STEMI-CS-OHCA and to 27.2 in STEMI-CS-IHCA (p<0.001).At 1-year, allcause mortality was 67.3% in STEMI-CS-no CA, 78.3% in STEMI-CS-OHCA (p=0.004) and 82.7% in STEMI-CS-IHCA (p<0.001) without significant difference between cardiac arrest subgroups (p=0.555). Conclusion:In STEMI-related CS, concomitant OHCA or IHCA is associated with distinct clinical profiles, coronary anatomy, intensity of treatment and markedly impaired long-term survival.
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Franco et al. (2026) conducted a cohort in Cardiogenic shock due to ST-elevation myocardial infarction (n=345). Cardiac arrest (out-of-hospital or in-hospital) vs. No cardiac arrest was evaluated on 1-year all-cause mortality (p=0.004). Concomitant out-of-hospital or in-hospital cardiac arrest in STEMI-related cardiogenic shock was associated with higher 1-year all-cause mortality (78.3% and 82.7%) vs no cardiac arrest (67.3%).
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