Predictors of Mortality in Cardiogenic Shock after Acute Myocardial Infarction with ST-Segment Elevation

Abstract Introduction: In patients with out-of-hospital cardiac arrest (OHCA) complicating an ST-segment elevation myocardial infarction (STEMI), the survival depends largely on the restoration of coronary flow in the infarct related artery. The aim of this study was to determine clinical and angiographic predictors of in-hospital mortality in patients with OHCA and STEMI, successfully resuscitated and undergoing primary percutaneous intervention (PCI).Methods: From January 2013 to July 2015, 78 patients with STEMI presenting OHCA, successfully resuscitated, transferred immediately to the catheterization unit and treated with primary PCI, were analyzed. Clinical, laboratory and angiographic data were compared in 28 non-survivors and 50 survivors.Results: The clinical baseline characteristics of the study population showed no significant differences between the survivors and non-survivors in respect to age (p=0.06), gender (p=0.8), the presence of hypertension (p=0.4), dyslipidemia (p=0.09) obesity (p=1), smoking status (p=0.2), presence of diabetes (p=0.2), a clinical history of acute myocardial infarction (p=0.7) or stroke (p=0.17). Compared to survivors, the non-survivor group exhibited a significantly higher incidence of cardiogenic shock (50% vs 24%, p=0.02), renal failure (64.3% vs 30.0%, p=0.004) and anaemia (35.7% vs 12.0%, p=0.02). Three-vessel disease was significantly higher in the non-survivor group (42.8% vs. 20.0%, p=0.03), while there was a significantly higher percentage of TIMI 3 flow postPCI in the infarct-related artery in the survivor group (80.% vs. 57.1%, p=0.03). The time from the onset of symptoms to revascularization was significantly higher in patients who died compared to those who survived (387.5 +/- 211.3 minutes vs 300.8 +/- 166.1 minutes, p=0.04), as was the time from the onset of cardiac arrest to revascularization (103.0 +/- 56.34 minutes vs 67.0 +/- 44.4 minutes, p=0.002). Multivariate analysis identified the presence of cardiogenic shock (odds ratio [OR]: 3.17, p=0.02), multivessel disease (OR: 3.0, p=0.03), renal failure (OR: 4.2, p=0.004), anaemia (OR: 4.07, p=0.02), need for mechanical ventilation >48 hours (OR: 8.07, p=0.0002) and a duration of stay in the ICU longer than 5 days (OR: 9.96, p=0.0002) as the most significant independent predictors for mortality in patients with OHCA and STEMI.Conclusion: In patients surviving an OHCA in the early phase of a myocardial infarction, the presence of cardiogenic shock, renal failure, anaemia or multivessel disease, as well as a longer time from the onset of symptoms or of cardiac arrest to revascularization, are independent predictors of mortality. However, the most powerful predictor of death is the duration of stay in the ICU and the requirement of mechanical ventilation for more than forty-eight hours.

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A Long-Forgotten Tale: The Management of Cardiogenic Shock in Acute Myocardial Infarction

Journal Of Cardiovascular Emergencies ◽

10.2478/jce-2018-0023 ◽

2018 ◽

Vol 4 (4) ◽

pp. 170-177

Author(s):

Adrian Corneliu Iancu ◽

Mihaela Ioana Dregoesc ◽

Aurelia Solomoneanu ◽

Theodora Benedek

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiogenic Shock ◽

Mechanical Support ◽

St Segment Elevation ◽

Medical Centers ◽

Life Saving ◽

St Segment ◽

Elevation Acute Myocardial Infarction ◽

Related Mortality

Abstract Patients with acute myocardial infarction (AMI) complicated with cardiogenic shock (CS) present one of the highest mortality rates recorded in critical care. Mortality rate in this setting is reported around 45-50% even in the most experienced and well-equipped medical centers. The continuous development of ST-segment elevation acute myocardial infarction (STEMI) networks has led not only to a dramatic decrease in STEMI-related mortality, but also to an increase in the frequency of severely complicated cases who survive to be transferred to tertiary centers for life-saving treatments. The reduced effectiveness of vasoactive drugs on a severely altered hemodynamic status led to the development of new devices dedicated to advanced cardiac support. What’s more, efforts are being made to reduce time from first medical contact to initiation of mechanical support in this particular clinical context. This review aims to summarize the most recent advances in mechanical support devices, in the setting of CS-complicated AMI. At the same time, the review presents several modern concepts in the organization of complex CS centers. These specialized hubs could improve survival in this critical condition.

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Acute Myocardial Infarction due to Multiple Thrombosis without Cardiogenic Shock

Medical Principles and Practice ◽

10.1159/000495004 ◽

2018 ◽

Vol 28 (1) ◽

pp. 87-90

Author(s):

Yurdaer Dönmez ◽

Armağan Acele ◽

Zikret Köse

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiogenic Shock ◽

Clinical Presentation ◽

Inferior Myocardial Infarction ◽

Thrombotic Occlusion ◽

Severe Chest Pain ◽

St Segment Elevation ◽

St Segment ◽

Severe Hypotension

Objective: Acute thrombotic occlusion of > 1 major coronary arteries is very rare (2.5%). Herein, we report a patient with simultaneous anterior and inferior myocardial infarction without cardiogenic shock. Clinical Presentation and Intervention: A 43-year-old woman was admitted with severe chest pain. Electrocardiography showed ST segment elevation in anterior and inferior derivations. There was no severe hypotension. Urgent coronary angiography showed that there were thrombotic occlusions in both left anterior descending artery and right coronary artery. Both lesions were successfully treated with coronary stenting. Conclusion: If there is multiple ST segment elevation on presentation electrocardiography, clinicians should be aware of possible simultaneous coronary occlusions.

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Epidemiological Trends in the Timing of In-Hospital Death in Acute Myocardial Infarction-Cardiogenic Shock in the United States

Journal of Clinical Medicine ◽

10.3390/jcm9072094 ◽

2020 ◽

Vol 9 (7) ◽

pp. 2094 ◽

Cited By ~ 3

Author(s):

Saraschandra Vallabhajosyula ◽

Shannon M. Dunlay ◽

Malcolm R. Bell ◽

P. Elliott Miller ◽

Wisit Cheungpasitporn ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiac Arrest ◽

Cardiogenic Shock ◽

Organ Failure ◽

The United States ◽

Hospital Death ◽

Do Not Resuscitate ◽

St Segment Elevation ◽

St Segment

Background: There are limited data on the epidemiology and timing of in-hospital death (IHD) in patients with acute myocardial infarction-cardiogenic shock (AMI-CS). Methods: Adult admissions with AMI-CS with IHDs were identified using the National Inpatient Sample (2000–2016) and were classified as early (≤2 days), mid-term (3–7 days), and late (>7 days). Inter-hospital transfers and those with do-not-resuscitate statuses were excluded. The outcomes of interest included the epidemiology, temporal trends and predictors for IHD timing. Results: IHD was noted in 113,349 AMI-CS admissions (median time to IHD 3 (interquartile range 1–7) days), with early, mid-term and late IHD in 44%, 32% and 24%, respectively. Compared to the mid-term and late groups, the early IHD group had higher rates of ST-segment-elevation AMI-CS (74%, 63%, 60%) and cardiac arrest (37%, 33%, 29%), but lower rates of acute organ failure (68%, 79%, 89%), use of coronary angiography (45%, 56%, 67%), percutaneous coronary intervention (33%, 36%, 42%), and mechanical circulatory support (31%, 39%, 50%) (all p < 0.001). There was a temporal increase in the early (adjusted odds ratio (aOR) for 2016 vs. 2000 2.50 (95% confidence interval (CI) 2.22–2.78)) and a decrease in mid-term (aOR 0.75 (95% CI 0.71–0.79)) and late (aOR 0.34 (95% CI 0.31–0.37)) IHD. ST-segment-elevation AMI-CS and cardiac arrest were associated with the increased risk of early IHD, whereas advanced comorbidity and acute organ failure were associated with late IHD. Conclusions: Early IHD after AMI-CS has increased between 2000 and 2016. The populations with early vs. late IHD were systematically different.

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TCT-266 Predictors of Mortality in Non-Anterior ST-segment Elevation Myocardial Infarction: Insights from the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) Trial

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2015.08.949 ◽

2015 ◽

Vol 66 (15) ◽

pp. B105

Author(s):

Gennaro Giustino ◽

Joe Dizon ◽

Philippe Genereux ◽

Roxana Mehran ◽

Mario Gössl ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

St Segment Elevation ◽

Predictors Of Mortality ◽

Segment Elevation Myocardial Infarction ◽

St Segment

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Pre-admission cardiac arrest in ST-segment elevation myocardial infarction: incidence, predictors and related outcomes

European Heart Journal ◽

10.1093/ehjci/ehaa946.1620 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

G.N.D Araujo ◽

J.L Luchese ◽

A.T Theobald ◽

R.B Beltrame ◽

G.M Machado ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiac Arrest ◽

Hospital Mortality ◽

Cardiogenic Shock ◽

St Segment Elevation ◽

Predictors Of Mortality ◽

Segment Elevation Myocardial Infarction ◽

Shockable Rhythm ◽

St Segment ◽

Temporary Pacemaker

Abstract Background/Introduction ST segment elevation myocardial infarction (STEMI) is a frequent cause of Cardiac Arrest (CA), and early percutaneous coronary intervention is associated with increased hospital survival in these patients. Despite constant improvements in out-of-hospital CA management, survival remains low. Purpose Our aim was to assess pre-admission CA incidence, predictors and related outcomes in patients admitted with STEMI. Methods We prospectively included 1083 patients admitted with STEMI in a tertiary university hospital in southern Brazil between March 2011 and October 2019. All patients were submitted to emergency coronary angiography. Baseline characteristics, details of the procedure, reperfusion strategies, and in-hospital outcomes were evaluated. Results Mean age was 60.8 years (± 12), 66.2% were male, 62% had hypertension and 25.3% had diabetes. Pre-admission CA was present in 104 (9.8%) patients. Patients with CA had more frequently previous myocardial infarction, temporary pacemaker, smoking and Killip 3 or 4 on admission, and shorter pain–to-door time than patients without CA. In addition, CA patients had a higher incidence of periprocedural CA, cardiogenic shock and periprocedural and in-hospital mortality. In multivariate analysis, age (RR= 0.96, p=0.001), anterior MI (RR=1.67, p=0.04) smoking (RR=0.57, p=0.04), previous ASA use (RR=0.40, p=0.02), Killip 3 or 4 (RR=14.71, p<0.001), temporary pacemaker (RR 2.53, p=0.01), pain-to-door time (RR=0.99, p=0.017) were independently associated with CA. Non Shockable Rhythm (RR=7.37, p=0.017), ROSC duration (RR=1.05, p=0.02) and cardiogenic shock (RR=31.2, p=0.003) were independent predictors of mortality among patients admitted with CA. Conclusion In this cohort of consecutive patients admitted with STEMI, pre-admission CA incidence was greater than seen in literature. Cardiogenic shock and in-hospital mortality were more common in patients admitted with CA, which may in part explain our higher rate of overall in-hospital mortality. Non shockable rhythm, increased ROSC and cardiogenic shock were independent predictors of mortality among patients admitted with CA. Understanding these characteristics may help taking measures to lower mortality rates. Funding Acknowledgement Type of funding source: None

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Abstract 90: Inhospital Outcome of 458 Patients with Acute Myocardial Infarction Requiring Mechanical Ventilation. Results of the BEAT Registry of the ALKK.

Circulation ◽

10.1161/circ.116.suppl_16.ii_942-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Uwe Zeymer ◽

Kleopatra Kouraki ◽

Steffen Schneider ◽

Herzzentrum Ludwigshafen ◽

Rainer Uebis ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Mechanical Ventilation ◽

Cardiogenic Shock ◽

Artery Bypass ◽

Severe Infection ◽

Inhospital Mortality ◽

Limited Information ◽

St Segment Elevation ◽

St Segment

Background: There is only limited information about characteristics and clinical outcome of patients with acute myocardial infarction (AMI) requiring endotracheal intubation and mechanical ventilation. Therefore we sought to evaluate the clinical course of a large cohort of patients with AMI and mechanical ventilation. Methods: The BEAT Registry of the ALKK prospectively enrolled all consecutive patients requiring mechanical ventilation, who were admitted to an internal intensiv care unit (ICU) of 45 participating German centers. Patient characteristics, treatment and complications until discharge were collected. For this analysis we created a subgroup of patients admitted with ST-segment elevation or non-ST Segment elevation myocardial infarction. Results : During the 9-month study period 458 consecutive patients with AMI were included. The mean age was 68±8 years and 71% were men. While 40% of the patients were intubated in the prehospital phase, 60% were intubated in the hospital. The initial cause for intubation was in 48% of the cases ventricular fibrillation/ tachycardia or sudden cardiac death, in 39% congestive heart failure and in 13% of the cases non-cardiac. Of the 458 patients 256 (56%) developed cardiogenic shock, 86 (19%) acute renal failure, 76 (17%) coma or brain damage, 64 (14%) severe infection, 46 (10%) sepsis, 28 (6%) MODS and 17 (4%) gastrointestinal bleeding. 204 (45%) patients underwent coronary angiography, 38% were treated with PCI and 5% with coronary artery bypass grafting. The inhospital mortality in the total group was 48% and in the subgroup of patients with cardiogenic shock 69%. Conclusion: Patients requiring mechanical ventilation as complication during the early phase of an AMI constitute a high risk subgroup with a mortality of 50%. Further research is necessary to improve the outcome of these patients.

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Abstract 13000: Trends in Incidence, Invasive Management and Outcomes of Cardiogenic Shock Complicating Non ST-Segment Elevation Myocardial Infarction

Circulation ◽

10.1161/circ.130.suppl_2.13000 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Navdeep Gupta ◽

Saurabh Aggarwal ◽

Yu Guo ◽

Sripal Bangalore

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hospital Mortality ◽

Cardiogenic Shock ◽

Nationwide Inpatient Sample ◽

Secondary Outcome ◽

Steady Increase ◽

St Segment Elevation ◽

St Segment ◽

Invasive Management

Background: Cardiogenic shock complicating Acute Myocardial Infarction (AMI) is usually described in the setting of a ST-segment elevation MI (STEMI). However, the trend in incidence, invasive management and outcomes of cardiogenic shock complicating NSTEMI, are not well defined. Methods: We analyzed patients in the Nationwide Inpatient Sample (NIS) between 2002-2011 with primary discharge diagnosis of Acute Myocardial Infarction (AMI) and secondary diagnosis of cardiogenic shock. Primary outcome was trend in cardiogenic shock complicating NSTEMI. Secondary outcome was trends in in-hospital mortality. Results: We identified 6,667,087 patients with AMI among which 4,032,193(60.5% of AMI) had NSTEMI and 2,634,894(39.5%) had STEMI. Cardiogenic shock complicated , 92,654(2.3%) patients with NSTEMI and 204,389(7.8%) patients with STEMI. Among patients with cardiogenic shock, there was a steady increase in proportion of patients with NSTEMI (vs. STEMI) (23.6% to 38.0% from 2002 to 2011, p<0.001). While an increasing percentage of NSTEMI shock patients underwent invasive management (55.1% to 67.3% from 2002 to 2011, p<0.001) this was significant lower when compared with STEMI shock (68.0% to 84.0% from 2002 to 2011, p<0.001) patients. Mortality in NSTEMI and STEMI shock patients were similar and continued to account for high in-hospital mortality (36.6% vs. 38.9%, P<0.001). Conclusions: Among patients with cardiogenic shock complicating AMI, there are an increasing proportion of patients with shock complicating NSTEMI. While the percentage of patients with NSTEMI shock undergoing invasive management has increased it continues to be lower as compared to STEMI shock despite similarly high in-hospital mortality.

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Prognosis of Patients With Cardiogenic Shock Following Acute Myocardial Infarction: The Difference Between ST-Segment Elevation Myocardial Infarction And Non-ST-Segment Elevation Myocardial Infarction

10.21203/rs.3.rs-841985/v1 ◽

2021 ◽

Author(s):

Ming-Lung Tsai ◽

Ming-Jer Hsieh ◽

Chun-Chi Chen ◽

Victor Chien-Chia Wu ◽

Wen-Ching Lan ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiogenic Shock ◽

Short Term ◽

Bleeding Rate ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Short Term Mortality

Abstract 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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