Differences Between STEMI and NSTEMI Complicated by Cardiogenic Shock

Figure 1. Initial and Peak Laboratory Values Tukey Box plots comparing admission and peak laboratory values in patients with ST-segment elevation myocardial infarction (STEMI) vs non–ST-segment elevation myocardial infarction (NSTEMI). Panels display lactate, creatinine, alanine aminotransferase (ALT), and white blood cell count (WBC), shown on logarithmic scales. P values reflect Mann-Whitney U test.

Central Illustration. STEMI-CS vs NSTEMI-CS: Profiles, Management, and Outcomes STEMI-CS patients were younger with more frequent cardiac arrest and advanced shock; NSTEMI-CS patients were older with greater comorbidity, multivessel disease, and concurrent chronic total occlusion. PCI and MCS predominated in STEMI-CS, whereas CABG was more common in NSTEMI-CS. Six-month mortality was similar despite these distinct profiles (STEMI-CS 37.1% vs NSTEMI-CS 34.0%; P = 0.53). On multivariable analysis, revascularization was associated with lower mortality in both phenotypes. IABP or pVAD was associated with lower mortality in STEMI-CS only; VA-ECMO was associated with higher mortality in both groups. AMI-CS = acute myocardial infarction complicated by cardiogenic shock; CABG = coronary artery bypass grafting; CAD = coronary artery disease; CKD = chronic kidney disease; CTO = chronic total occlusion; DM = Diabetes mellitus; IABP = intra-aortic balloon pump; MCS = mechanical circulatory support; NSTEMI-CS = non–ST-segment elevation myocardial infarction with cardiogenic shock; PAC = pulmonary artery catheter; PCI = percutaneous coronary intervention; pVAD = percutaneous ventricular assist device; RRT = renal…

Figure 2. Procedural Use by Hospital Capability Level and Acute Myocardial Infarction Complicated by Cardiogenic Shock Subtype Proportion of patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) undergoing each procedure, stratified by AMI-CS subtype and receiving-hospital level: (A; STEMI-CS n = 780, NSTEMI-CS n = 550) all centers capable of transplant/extracorporeal membrane oxygenation (ECMO)/percutaneous coronary intervention (PCI), (B; STEMI-CS n = 311, NSTEMI-CS n = 251) transplant-capable centers, (C; STEMI-CS n = 425, NSTEMI-CS n = 261) ECMO-capable centers, and (D; STEMI-CS n = 44, NSTEMI-CS n = 38) PCI-only centers. Bars are color-coded by procedure; solid fills denote STEMI-CS and hatched fills denote NSTEMI-CS. STEMI-CS vs NSTEMI-CS prevalence was compared within each level using the chi-square or Fisher exact test, with Bonferroni correction for the 5 procedures tested per level. ∗P < 0.05, ∗∗P < 0.01, ∗∗∗P < 0.001. AMI = acute myocardial infarction; CABG = coronary artery bypass grafting; IABP/pVAD = intra-aortic balloon pump or percutaneous ventricular assist device; LHC = left heart catheterization; NSTEMI = non–ST-elevation myocardial…

Figure 3. Multivariable Predictors of 6-Month Mortality by Acute Myocardial Infarction Complicated by Cardiogenic Shock Phenotype Multivariable logistic regression for cumulative all-cause mortality at 6 months from the index admission fit separately in STEMI-CS and NSTEMI-CS. Twelve covariates were modeled simultaneously. Portrayed are the significant associations (all 12 covariates are portrayed in Supplemental Figure 2); missing data were handled by multiple imputation by chained equations (MICE). Bold OR (95% CI) and P value entries indicate P < 0.05. The reference line is at OR = 1; the x-axis is log-scaled. Abbreviations as in Figure 2.