Key result
Cardiogenic shock in STEMI is linked to a ~7-fold increased in-hospital mortality risk.
Why the study?
The clinical pattern and outcomes of cardiogenic shock complicating STEMI have never been described in the Malaysian setting.
Does percutaneous coronary intervention reduce mortality compared to non-invasive therapy in patients with STEMI complicated by cardiogenic shock?
Observational (n=16,517)
Yes
Does percutaneous coronary intervention reduce mortality compared to non-invasive therapy in patients with STEMI complicated by cardiogenic shock?
Effect estimate: 7.14 times mortality risk increment
In a large Malaysian registry, cardiogenic shock complicated 10.6% of STEMI cases and carried a 34.1% in-hospital mortality rate, which was significantly reduced by the use of percutaneous coronary intervention.
High mortality in STEMI with shock demands heightened vigilance; observational data leaves open whether PCI improves survival.
OBJECTIVES: Cardiogenic shock (CS) complicating ST-elevation myocardial infarction (STEMI) carries an extremely high mortality. The clinical pattern of this life threatening complication has never been described in Malaysian setting. This study is to investigate the incidence, clinical characteristics and outcome of STEMI patients with CS in our population. DESIGN: A retrospective analysis of STEMI patients from 18 hospitals across Malaysia contributing to the Malaysian National Cardiovascular Database-acute coronary syndrome) registry (NCVD-ACS) year 2006-2013. PARTICIPANTS: 16 517 patients diagnosed of STEMI from 18 hospitals in Malaysia from the year 2006 to 2013. PRIMARY OUTCOME MEASURES: In-hospital and 30 day post-discharge mortality. RESULTS: CS complicates 10.6% of all STEMIs in this study. They had unfavourable premorbid conditions and poor outcomes. The in-hospital mortality rate was 34.1% which translates into a 7.14 times mortality risk increment compared with STEMI without CS. Intravenous thrombolysis remained as the main urgent reperfusion modality. Percutaneous coronary interventions (PCI) in CS conferred a 40% risk reduction over non-invasive therapy but were only done in 33.6% of cases. Age over 65, diabetes mellitus, hypertension, chronic lung and kidney disease conferred higher risk of mortality. CONCLUSION: Mortality rates of CS complicating STEMI in Malaysia are high. In-hospital PCI confers a 40% mortality risk reduction but the rate of PCI among our patients with CS complicating STEMI is still low. Efforts are being made to increase access to invasive therapy for these patients.
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Venkatason et al. (2019) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=16,517). Cardiogenic shock vs. STEMI without cardiogenic shock was evaluated on In-hospital and 30 day post-discharge mortality (7.14 times mortality risk increment). Cardiogenic shock complicating STEMI was associated with a 34.1% in-hospital mortality rate, representing a 7.14-fold increased mortality risk compared to STEMI without cardiogenic shock.
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