Characteristics and clinical predictors of cardiogenic shock among patients presenting with acute ST-segment elevation myocardial infarction

Q: What are the key findings of this study?

Ventricular arrhythmia (OR 3.69) and dyslipidemia (OR 2.39) emerged as strong independent predictors of cardiogenic shock in a Saudi STEMI cohort, whereas classical predictors like age and diabetes did not.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute ST-segment elevation myocardial infarction (STEMI) (n=878). Intervention: Ventricular arrhythmia vs. No ventricular arrhythmia. Primary outcome: Development of cardiogenic shock (OR 3.69, 95% CI 1.63-8.37, p=0.002).

Q: What does this research mean for the field?

Ventricular arrhythmia and dyslipidemia are independent predictors of cardiogenic shock in Saudi patients with STEMI, whereas classical Western predictors such as age, diabetes, and infarct location are not. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ahmed Hamad Aljizeeri; Nuwayyir Abdullah Alqasimi; Lujain Hatim Aljohani; Farah Mohammed Alharbi; Yazeed Abdullah Asery; Sultan Alnashmi Alqasim; Naif Suliman Alaqil; Mohamed A Albugami; Sultan Saleh Alotaibi; Talal S Alharbi; Amjad M.A. Ahmed; Ihab F. Suliman

doi:10.24911/amem.15-2828

August 15, 2026Annals of Middle Eastern MedicineOpen Access

Characteristics and clinical predictors of cardiogenic shock among patients presenting with acute ST-segment elevation myocardial infarction

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Key result

Ventricular arrhythmia is linked to ~3.7-fold higher odds of cardiogenic shock in STEMI.

OR 3.69
95% CI 1.63-8.37
P=0.002
n=878

Why the study?

Contemporary local data on cardiogenic shock in patients with acute STEMI in Saudi Arabia are limited despite a younger population and higher diabetes burden compared to Western cohorts.

Key Points

To determine the incidence, clinical characteristics, and independent predictors of cardiogenic shock among patients presenting with acute STEMI at a tertiary cardiac center in Saudi Arabia.
Single-center retrospective cohort study of consecutive adult patients with acute STEMI admitted to King Abdulaziz Cardiac Center in Riyadh between January 2019 and December 2024 (N=878).
All patients underwent primary percutaneous coronary intervention; cardiogenic shock was defined according to SHOCK trial criteria.
Univariate and multivariate logistic regression analyses were performed to identify independent clinical and laboratory predictors of cardiogenic shock.
Cardiogenic shock developed in 80 of 878 patients (9.1%), who had higher rates of dyslipidemia (58.8% vs. 44.6%, p = 0.016) and ventricular arrhythmia (17.5% vs. 5.5%, p < 0.001) compared to those without shock.
In multivariate analysis, independent predictors of increased shock odds included dyslipidemia (OR 2.39, 95% CI 1.22-4.70), arrhythmia (OR 3.69, 95% CI 1.63-8.37), peak troponin (p = 0.040), and peak blood urea nitrogen (OR 1.05, 95% CI 1.01-1.08).
Independent protective factors against shock included female sex (OR 0.18, 95% CI 0.06-0.52), nadir hemoglobin (OR 0.97, 95% CI 0.96-0.99), and nadir potassium (OR 0.16, 95% CI 0.07-0.34), whereas age, diabetes, and infarct location were not significant.

Study Design

Type

Cohort (n=878)

Multicenter

No

Structured PICO

P

Population

878 adult patients with acute ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention, evaluated during their index hospital admission.

O

Outcome

Occurrence of cardiogenic shock during the index admission, defined by SHOCK trial criteria (systolic blood pressure < 90 mmHg sustained for ≥ 1 hour, with signs of tissue hypoperfusion unresponsive to fluid resuscitation).hard clinical

Main Result

Odds Ratio: 3.69 (95% CI 1.63–8.37)

p-value: p=0.002

In a contemporary Saudi STEMI cohort presenting at a younger age with a high burden of diabetes, cardiogenic shock remained frequent (9.1%) but was driven by atypical predictors like dyslipidemia and arrhythmia rather than classical Western predictors like advanced age.

Limitations

Single-center study design limiting generalizability
Lack of data on ischemia time, reperfusion time, and right ventricular involvement
Inability to adjust for left main or multivessel coronary artery disease
Retrospective design subject to documentation bias and unmeasured confounding
Low events-per-variable ratio in the multivariate model causing wide confidence intervals
In-hospital and longer-term mortality not analyzed
Single-center study, potentially limiting generalizability to other Saudi or regional populations.
Sparse data for certain subgroups (e.g., female patients with shock) resulting in wide confidence intervals for some multivariate odds ratios.
Several laboratory variables were right-skewed, requiring descriptive presentation as mean ± SD with non-parametric testing.
In-hospital and longer-term mortality were not analyzed in this manuscript.

Implication

Ventricular arrhythmia and dyslipidemia may flag cardiogenic shock risk in younger Saudi STEMI patients; challenges consensus on classical predictors and leaves open prospective validation.

Abstract

Background: Cardiogenic shock (CS) is the leading cause of mortality in ST-segment elevation myocardial infarction (STEMI). Patients with acute coronary syndrome in Saudi Arabia present a decade younger than Western cohorts and have a higher diabetes burden, yet contemporary local data on CS are limited. We aimed to determine the incidence, characteristics, and predictors of CS in a Saudi STEMI cohort. Methods: Single-center retrospective cohort study of consecutive adult patients with acute STEMI admitted to King Abdulaziz Cardiac Center, Riyadh, from January 2019 to December 2024. CS was defined by the SHOCK trial criteria. Univariate and multivariate logistic regression identified independent predictors. Results: A total of 878 patients were included (mean age 57.2 ± 13.6 years; 86.6% male); 80 (9.1%) developed CS. Compared with patients without CS, those with CS had a higher prevalence of dyslipidemia (58.8% vs. 44.6%, p = 0.016) and ventricular arrhythmia (17.5% vs. 5.5%, p < 0.001), higher peak troponin and N-terminal pro-B-type natriuretic peptid, and lower hemoglobin, sodium, potassium, and estimated glomerular filtration rate. No differences were observed in age, sex, hypertension, diabetes, or infarct location. In multivariate analysis, independent predictors of CS were female sex odds ratio (OR 0.18, 95% confidence intervals 0.06-0.52), dyslipidemia (OR 2.39, 1.22-4.70), arrhythmia (OR 3.69, 1.63-8.37), peak troponin (p = 0.040), peak blood urea nitrogen (OR 1.05, 1.01-1.08), nadir hemoglobin (OR 0.97, 0.96-0.99), and nadir potassium (OR 0.16, 0.07-0.34). Conclusion: CS occurred in 9.1% of this contemporary Saudi STEMI cohort. The predictors that emerged were not the classical Western ones; larger multicenter studies should confirm these findings and inform regional risk stratification.

Discussion

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Cite This Study

Aljizeeri et al. (2026) conducted a cohort in Acute ST-segment elevation myocardial infarction (STEMI) (n=878). Ventricular arrhythmia vs. No ventricular arrhythmia was evaluated on Development of cardiogenic shock (OR 3.69, 95% CI 1.63-8.37, p=0.002). Ventricular arrhythmia (OR 3.69) and dyslipidemia (OR 2.39) emerged as strong independent predictors of cardiogenic shock in a Saudi STEMI cohort, whereas classical predictors like age and diabetes did not.

synapsesocial.com/papers/6ad0fcb515427f6a840402f3 https://doi.org/10.24911/amem.15-2828

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Characteristics and clinical predictors of cardiogenic shock among patients presenting with acute ST-segment elevation myocardial infarction

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Characteristics and clinical predictors of cardiogenic shock among patients presenting with acute ST-segment elevation myocardial infarction

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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