Key result
Cardiogenic shock at admission is not linked to long-term CV mortality in ACS survivors.
Why the study?
While the link between cardiogenic shock and in-hospital mortality in acute coronary syndrome is established, its prognostic influence on long-term outcome is less clear.
Does cardiogenic shock at admission increase long-term cardiovascular mortality in patients undergoing primary PCI who survive the acute event?
Cohort (n=1,173)
No
Does cardiogenic shock at admission increase long-term cardiovascular mortality in patients undergoing primary PCI who survive the acute event?
Hazard Ratio: 1.18 (95% CI 0.77–1.81)
Absolute Event Rate: 24% vs 23.5%
p-value: p=0.457
Among patients undergoing primary PCI who survive the initial acute event, presenting with cardiogenic shock does not worsen long-term cardiovascular survival compared to those without cardiogenic shock.
Supports no differential long-term mortality risk stratification by admission shock status in primary PCI survivors; hypothesis-generating and should not yet change practice.
Although a strong association of cardiogenic shock (CS) with in-hospital mortality in patients with acute coronary syndrome (ACS) is well established, less attention has been paid to its prognostic influence on long-term outcome. We evaluated the impact of CS in 1173 patients undergoing primary percutaneous coronary interventions between 1997 and 2009. Patients were followed up until the primary study endpoint (cardiovascular mortality) was reached. Within the entire study population, 112 (10.4%) patients presented with CS at admission. After initial survival, CS had no impact on mortality (non-CS: 23.5% vs. CS: 24.0%; p = 0.923), with an adjusted hazard ratio of 1.18 (95% CI: 0.77–1.81; p = 0.457). CS patients ≥ 55 years (p = 0.021) with moderately or severely impaired left ventricular function (LVF; p = 0.039) and chronic kidney disease (CKD; p = 0.013) had increased risk of cardiovascular mortality during follow-up. The present investigation extends currently available evidence that cardiovascular survival in CS is comparable with non-CS patients after the acute event. CS patients over 55 years presenting with impaired LVF and CKD at the time of ACS are at increased risk for long-term mortality and could benefit from personalized secondary prevention.
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Steinacher et al. (2022) conducted a cohort in Acute Coronary Syndrome (n=1,173). Cardiogenic shock at admission vs. No cardiogenic shock at admission was evaluated on Cardiovascular mortality during long-term follow-up (after surviving the initial hospital stay) (HR 1.18, 95% CI 0.77-1.81, p=0.457). Cardiogenic shock at admission did not significantly impact long-term cardiovascular mortality in acute coronary syndrome patients who survived the initial hospitalization (adjusted HR 1.18).
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