Key result
In patients with cardiogenic shock, STEMI was associated with significantly higher in-hospital mortality compared to NSTEMI (34.2% vs. 28.8%; aRR 1.19, 95% CI 1.14-1.23).
Why the study?
To compare in-hospital management and outcomes in patients with cardiogenic shock due to STEMI versus NSTEMI.
Does STEMI compared to NSTEMI impact in-hospital mortality and management in patients with cardiogenic shock?
Cohort (n=150,395)
Yes
Does STEMI compared to NSTEMI impact in-hospital mortality and management in patients with cardiogenic shock?
Patients with cardiogenic shock due to STEMI have higher in-hospital mortality and major bleeding compared to those with NSTEMI, despite higher use of PCI and mechanical circulatory support.
Answers are grounded in this paper and cite their sources.
STEMI shock linked to worse outcomes and more interventions than NSTEMI; leaves open whether targeted strategies improve prognosis.
Background: Our study aims to compare in-hospital management and outcomes in patients with cardiogenic shock due to ST-segment elevation myocardial infarction (STEMI) versus non-ST-segment elevation myocardial infarction (NSTEMI). Methods: We conducted a retrospective cohort study using the National Inpatient Sample database between 2016-2019, including patients with STEMI/NSTEMI complicated by cardiogenic shock. An inverse probability treatment weighting analysis was performed to compare in-hospital management and outcomes between patients with STEMI and NSTEMI. Adjusted relative risks (aRR) with their 95% confidence intervals (CIs) were estimated. Results: A total of 150,395 patients with cardiogenic shock due to acute myocardial infarction were included, of whom 52.8% had STEMI. The median age was 68 years (60-77) and 35% were female. Percutaneous coronary intervention, intra-aortic balloon counterpulsation, percutaneous ventricular assist device, extracorporeal membrane oxygenation, and mechanical ventilation use were significantly higher in the STEMI group compared to NSTEMI. Coronary artery bypass grafting, renal replacement therapy, length of hospital stay, and total costs were lower in the STEMI group. Pulmonary arterial catheterization and cardiac transplantation were similar between both groups. Inverse probability treatment weighting analysis showed that in-hospital mortality was significantly higher in the STEMI group compared to NSTEMI (34.2% vs. 28.8%, aRR 1.19, 95% CI 1.14-1.23) and also major bleeding. Conclusion: In conclusion, patients with cardiogenic shock due to STEMI had worse prognosis, higher use of percutaneous coronary intervention/mechanical circulatory support, and major bleeding than the NSTEMI group. In contrast, patients with NSTEMI had greater use of coronary artery bypass grafting and hospital resources.
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Diaz‐Arocutipa et al. (2024) conducted a cohort in Cardiogenic shock due to acute myocardial infarction (n=150,395). STEMI vs. NSTEMI was evaluated on In-hospital mortality (aRR 1.19, 95% CI 1.14-1.23). In patients with cardiogenic shock, STEMI was associated with significantly higher in-hospital mortality compared to NSTEMI (34.2% vs. 28.8%; aRR 1.19, 95% CI 1.14-1.23).
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