Key result
Age, stroke, and anterior STEMI associate with late cardiogenic shock in 10% of suspected STEMI admissions.
Why the study?
What are the incidence, timing, and risk factors for cardiogenic shock and mortality in patients with suspected STEMI admitted for acute coronary angiography?
Cohort
Yes
What are the incidence, timing, and risk factors for cardiogenic shock and mortality in patients with suspected STEMI admitted for acute coronary angiography?
In a contemporary STEMI cohort, 10% of patients developed cardiogenic shock, with specific clinical variables predicting late onset and high mortality irrespective of timing.
May aid risk stratification for late cardiogenic shock in STEMI; leaves open whether targeted interventions improve outcomes.
BACKGROUND: The incidence of cardiogenic shock (CS) in patients with ST-segment elevation myocardial infarction (STEMI) is as high as 10%. The majority of patients are thought to develop CS after admission (late CS), but the incidence in a contemporary STEMI cohort admitted for primary percutaneous intervention remains unknown. AIM: The aim of this study was to assess the incidence and time of CS onset in patients with suspected STEMI admitted in two high-volume tertiary heart centres and to assess the variables associated with the development of late CS. METHODS: We included consecutive patients admitted for acute coronary angiography with suspected STEMI in a 1-year period. Cardiogenic shock was based on clinical criteria and subdivided into patients with shock on admission, patients developing shock during catheterisation and patients developing shock later during hospitalisation. Follow-up for all-cause mortality was done using registries. Age, stroke, time from symptom onset to intervention, anterior STEMI, heart rate/systolic blood pressure ratio and being comatose after resuscitation from cardiac arrest were independently associated with the development of late CS. CONCLUSION: In this study, 10% of patients admitted with suspected STEMI for acute coronary angiography presented with or developed CS. Most were in shock on admission. Irrespective of the timing of shock, mortality was high.
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Obling et al. (2017) conducted a cohort in ST-segment elevation myocardial infarction (STEMI). Age, stroke, anterior STEMI, and other clinical variables were independently associated with the development of late cardiogenic shock, which affected 10% of patients admitted with suspected STEMI.
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