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%).
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.
Absolute Event Rate: 78.3% vs 67.3%
p-value: p=0.004
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.
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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