Predictors for Mortality in Cardiogenic Shock Associated with ST-Segment Elevation Myocardial Infarction

Background and Objectives:

Cardiogenic shock (CS) complicating acute ST-segment elevation myocardial infarction (STEMI) is associated with high mortality. Despite advances in pharmacotherapy, catheter based interventions, and circulatory support, mortality remains unchanged.

We aimed to evaluate predictors for mortality, to allow for risk stratification and identification of patients that are at outmost risk for death.

Methods:

We analyzed 198 consecutive patients presenting with CS and STEMI and who underwent primary PCI in Rabin Medical Center between 2001-2017. Patients were evaluated for their demographic, clinical and angiographic characteristics. One- month and one-year all-cause mortality were evaluated.

Results:

Patients were predominantly older (68±13), males (70%). They had high rates of diabetes mellitus (DM), renal failure, and anemia. Patients predominantly presented with anterior wall STEMI (53%), low ejection fraction (EF) [79%] and multi-vessel disease (MVD) [79%]. Intra-aortic balloon pump (IABP) was used in high proportion of patients (72%). Mortality remained high at both one-month (47%) and one-year (55%) of admission. Univariate analysis revealed renal failure, DM, anemia, low EF, and MVD correlate with one-month and one-year mortality, while MVD-PCI, and use of IABP did not. Logistic regression revealed renal failure correlated with one-month mortality (OR 3.3; 95% CI 1.5-7.5, p=0.0002) and so did low EF (OR 6.4; 95% CI 2.1-19, p=0.0009). Renal failure (OR 3.9; 95% CI 1.6-9.6, p=0.0025) and low EF (OR 8.4; 95% CI 2.7-26, p=0.0002) correlated with one-year mortality as well.

Conclusions:

In patients presenting with STEMI and CS, renal failure and low EF correlated with mortality while use of IABP and MVD-PCI did not.