Key result
Admission cardiogenic shock predicts ~174% higher long-term cardiac death risk in STEMI patients.
Why the study?
The outcomes of different onset stages of cardiogenic shock in STEMI patients undergoing primary PCI were not well characterized.
Does the onset stage of cardiogenic shock (on admission vs developed during hospitalization) affect short-, mid-, and long-term outcomes in STEMI patients undergoing primary PCI?
Cohort (n=675)
No
Does the onset stage of cardiogenic shock (on admission vs developed during hospitalization) affect short-, mid-, and long-term outcomes in STEMI patients undergoing primary PCI?
Hazard Ratio: 2.739 (95% CI 1.21–6.204)
p-value: p=0.016
STEMI patients presenting with cardiogenic shock on admission have worse long-term outcomes compared to those who develop shock later or do not develop shock, highlighting the need for early prevention and management.
CS onset timing may stratify long-term STEMI risk; leaves open whether preventing in-hospital CS improves outcomes.
OBJECTIVES: The study was conducted to evaluate the outcomes of different onset stage of cardiogenic shock (CS) in the patients with ST-segment elevation myocardial infarction (STEMI). METHODS: Total 675 STEMI patients who had undergone primary percutaneous coronary intervention (pPCI) from November 2010 to December 2017 in Nanjing Drum Tower Hospital were enrolled. According to the onset time of CS, the cohort was divided into three groups: Non-CS group, CS on admission group and Developed CS group. The short-term (30 days), middle-term (12 months) and long-term (80 months) outcomes were analyzed. COX proportional hazard models were established for identification of the predictors. RESULTS: The all cause death, cardiac death and major adverse cardiac events (MACE) at 30 days were similar among the three groups. The incidence of MACE in the CS on admission group was significantly higher than the other two groups at 12 months. As to the long-term outcomes, the CS on admission group had lower survival rate than the other two groups. The Develop CS group had lower survival rate than Non-CS group numerically with a trend towards statistical significance. The incidence of cardiac death in the Non-CS group was the lowest. The incidence of MACE in the CS on admission group was much higher compared with the other two groups. After multivariate analysis, the independent predictors of all cause death included age, male sex, prior stroke and LVEF. The independent predictors of cardiac death included age, male sex, prior stroke, LVEF, CS on admission and developed CS. The independent predictors of MACE included age, prior stroke, LVEF, multivessel lesions, post-PCI TIMI grade 1 and CS on admission. CONCLUSIONS: The long-term outcomes of CS on admission group were the worst of all. The outcomes of Developed CS group laid between the other two groups. The consequences highlighted the importance of prevention for CS developing in the STEMI patients during hospitalization.
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Qiao et al. (2020) conducted a cohort in ST-segment elevation myocardial infarction (n=675). Cardiogenic shock on admission vs. No cardiogenic shock was evaluated on Long-term cardiac death (HR 2.739, 95% CI 1.210-6.204, p=0.016). Cardiogenic shock on admission independently predicted long-term cardiac death in STEMI patients compared to those without cardiogenic shock (HR 2.739).
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