Key result
Cardiogenic shock deterioration in stable AMI is linked to an ~13-fold higher in-hospital mortality.
Why the study?
Deterioration of Society of Cardiovascular Angiography and Intervention shock stages after acute myocardial infarction initially presenting with stable hemodynamic condition remains to be fully characterized.
Cohort (n=510)
No
Hazard Ratio: 12.95 (95% CI 1.46–114.97)
p-value: p=0.02
A risk score comprising initial systolic blood pressure, LVEF, and TIMI flow grade can predict the deterioration of cardiogenic shock and in-hospital mortality in initially stable AMI patients.
Warrants close monitoring for shock progression in stable AMI; hypothesis-generating for preventive strategies pending validation.
Background: The Society of Cardiovascular Angiography and Intervention (SCAI) has defined 5 stages of cardiogenic shock (CS). In patients with acute myocardial infarction (AMI) who initially present in stable hemodynamic condition (SCAI CS stage: A or B), CS stages could deteriorate despite therapeutic management. However, deterioration of SCAI CS stages after AMI remains to be fully characterized. Therefore, the current study sought to investigate the frequency and clinical characteristics about deterioration of SCAI CS stages after AMI. Methods: We retrospectively analyzed 347 patients in a derivation cohort and 163 patients in a validation cohort who had AMI (SCAI shock stage upon arrival: A/B) and underwent percutaneous coronary intervention (PCI) at National Cerebral and Cardiovascular Center, Suita, Japan (enrolment period of study subjects: 2019.07.01-2022.09.30). Deterioration of CS (D-CS) was defined as SCAI shock stage C-E after PCI. Clinical characteristics and in-hospital mortality were compared according to D-CS status. Adjusted hazard ratios (HRs) for in-hospital mortality were calculated with multivariate Cox proportional hazards models that included variables with P<0.10 in univariate models. Uni- and multivariate logistic regression analyses were used to identify predictors of D-CS. Results: D-CS occurred in 17.3% (60/347) of the derivation cohort. Patients with D-CS had lower systolic blood pressure (BP) (P<0.001) and left ventricular ejection fraction (LVEF) (P<0.001) upon arrival with a higher proportion of initial Thrombolysis in Myocardial Infarction (TIMI) grade flow 0 or 1 (P=0.002). During hospitalization (13.9±9.4 days), D-CS was associated with higher in-hospital mortality [adjusted HR, 12.95; 95% confidence interval (CI): 1.46-114.97; P=0.02]. Initial systolic BP, LVEF, and TIMI grade flow 0 or 1 independently predicted D-CS. The D-CS risk score including these variables satisfactorily predicted D-CS [area under the curve (AUC), 0.749; 95% CI: 0.651-0.848] and in-hospital mortality (AUC, 0.961; 95% CI: 0.914-1.000) in the validation cohort. Conclusions: D-CS occurred in 17.3% of patients with AMI initially presenting in stable condition and increased the risk of in-hospital mortality. Our D-CS risk score (initial systolic BP, LVEF, and TIMI grade flow) could be helpful to predict D-CS.
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Mukaida et al. (2024) conducted a cohort in Acute myocardial infarction initially presenting in stable hemodynamic condition (n=510). Deterioration of cardiogenic shock (D-CS) vs. No deterioration of cardiogenic shock was evaluated on In-hospital mortality (adjusted HR 12.95, 95% CI 1.46-114.97, p=0.02). Deterioration of cardiogenic shock occurred in 17.3% of stable AMI patients and was associated with significantly higher in-hospital mortality (adjusted HR 12.95; 95% CI 1.46-114.97; P=0.02).
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