Key result
Advancing SCAI shock stage linked to ~2.4-fold higher in-hospital mortality in MI cardiogenic shock.
Why the study?
To assess the features of the course of myocardial infarction across different SCAI stages in patients with MI complicated by cardiogenic shock.
Cohort (n=117)
No
Absolute Event Rate: 88.5% vs 37.5%
p-value: p=≤0.001
In patients with acute myocardial infarction complicated by cardiogenic shock, in-hospital mortality predictably increases with advancing SCAI shock stages, with low pH and low admission monocyte counts serving as strong predictors of shock severity.
SCAI staging stratifies mortality risk in MI shock; confirms association in this cohort but leaves open whether it guides therapy.
Aim: To access the features of the course of myocardial infarction (MI) in patients with different stages of MI complicated by cardiogenic shock (MI CS) according to the SCAI scale. Methods: We retrospectively described the portrait of CS MI (n = 117) at different stages of SCAI from the hospital MI registry (n = 1253). Results: Hospital mortality increased from stage to stage (p ≤ 0.001). Significant differences in biochemical parameters were found both for indicators characterizing intensive care measures, such as the presence of mechanical lung ventilation or an intra-aortic balloon pump, and for indicators of organ hypoperfusion such as lactate level, pHv (7.39 (7.36; 7.44) at stage A–B; 7.14 (7.06; 7.18) at stage E), creatinine, and glomerular filtration rate. Parameters related to MI characteristics, such as instrumental and laboratory data, anamnesis of ischemia, and performed treatment, did not differ between groups. Polynomial logistic regression showed that lactate level, mechanical ventilation, and monocyte count upon admission (1.15 (0.96; 1.23) at stage A–B; 0.78 (0.49; 0.94) at stage E, p = 0.005) correlated with CS severity. Conclusion: The characteristics of MI at different stages of SCAI do not have differences and do not determine the severity of shock. We revealed a high discriminatory potential of the pH level in predicting refractory shock. The value of monocytes at admission may be a promising predictor of the severity of MI CS. The question of the causes of heterogeneity of MI CS, taking into account the homogeneity of MI characteristics, remains open and promising.
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Ryabov et al. (2023) conducted a cohort in Acute Myocardial Infarction-Related Cardiogenic Shock (n=117). Advanced SCAI shock stages vs. Early SCAI shock stages (A-B) was evaluated on In-hospital mortality (p=≤0.001). In-hospital mortality increased significantly with advancing SCAI shock stage in patients with myocardial infarction-related cardiogenic shock, rising from 37.5% in stages A-B to 88.5% in stage E (p≤0.001).
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