Key result
In patients with acute myocardial infarction complicated by cardiogenic shock, NSTEMI was associated with a significantly higher short-term mortality rate compared to STEMI (21.30% vs. 14.83%).
Why the study?
Acute myocardial infarction complicated by cardiogenic shock carries high mortality and remains challenging in the revascularization era, prompting this study to evaluate patient outcomes.
Does STEMI compared to NSTEMI reduce mortality in patients with AMI complicated by cardiogenic shock?
Cohort (n=1,175)
Yes
Does STEMI compared to NSTEMI reduce mortality in patients with AMI complicated by cardiogenic shock?
Absolute Event Rate: 21.3% vs 14.83%
p-value: p=0.004
In patients with AMI complicated by cardiogenic shock, NSTEMI is associated with significantly higher short- and long-term mortality compared to STEMI, despite lower bleeding risks.
High mortality persists in AMI-CS; leaves open optimal management strategies beyond revascularization.
Background: Acute myocardial infarction (AMI) complicated with cardiogenic shock has high mortality and is a challenging topic even in the revascularization era. We conducted this study to understand patients’ outcomes.Method: We retrospectively analyzed electronic medical records data from 1,175 patients with AMI complicated with cardiogenic shock developed within 3 days of admission to a multicenter medical care system between January 1, 2000, and July 31, 2018. AMI patients were classified into ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI) group. The short-term and 1-year mortality and adverse event after the index admission were analyzed via logistic regression and Cox proportional hazards model. Results: Comparing to NSTEMI, patients with STEMI tended to be younger (65.68 ± 14.05 vs. 70.70 ± 12.99, p < .001), men (73.29 vs. 60.87, p < .001), and have fewer underlying chronic diseases. Short-term mortality at index hospitalization was 14.83% in the STEMI group and 21.30% in the NSTEMI group; long-term mortality was 17.06% for the STEMI group and 24.13% for the NSTEMI group. No difference was observed between the 2 groups for patients who developed a cerebral vascular accident (CVA) during the admission period; however, the major bleeding rate and gastrointestinal bleeding rate were higher in the STEMI group (2.66 vs. 0.22, p = .014; 3.36 vs. 0.22, p = .007, respectively). Conclusion: In patients with AMI with cardiogenic shock, NSTEMI was associated with a significantly higher mortality rate in both the short-and long-term results. Age and respiratory failure were the most significant risk factors for short-term mortality. Revascularization may be beneficial for the short-term outcome but did not reach significance in multivariable analysis.
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Tsai et al. (2021) conducted a cohort in Acute myocardial infarction complicated with cardiogenic shock (n=1,175). Non-ST-segment elevation myocardial infarction (NSTEMI) vs. ST-segment elevation myocardial infarction (STEMI) was evaluated on Mortality at index hospitalization (p=0.004). In patients with acute myocardial infarction complicated by cardiogenic shock, NSTEMI was associated with a significantly higher short-term mortality rate compared to STEMI (21.30% vs. 14.83%).
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