Incidence of Cardiogenic Shock in ST-Segment Elevated Myocardial Infarction
In-hospital mortality was elevated among those who presented with cardiogenic shock during their index hospitalization.
Variation in ischemic time among patients with ST-segment elevation myocardial infarction (STEMI) can affect the incidence of cardiogenic shock mortality, according to research presented at the 66th Annual Scientific Session & Expo of the American College of Cardiology.
Researchers from the Loma Linda University Medical Center in California conducted a retrospective study of data from 766 patients who presented with STEMI to a tertiary care university medical center between 2008 and 2015. Researchers used 2 sample t-tests to compare ischemic time in patients with (n=56) and without a cardiogenic shock diagnosis; a chi-squared test was used to compare in-hospital mortality between both groups.
Incidence of cardiogenic shock was not affected by ischemic time (P =.75), although patients with cardiogenic shock during index hospitalization experienced significantly higher mortality rates (34% vs 4%; P <.001). Patients presenting with syncope were at an increased risk for cardiogenic shock (odds ratio [OR], 4.9; 95% CI, 1.50-15.81); conversely, patients presenting with chest pain were at a decreased risk (OR, 0.27; 95% CI, 0.15-0.49).
One identified risk factor for cardiogenic shock included elevated body mass index (BMI), with a 6.7% increased risk for every unit of BMI greater than 25 kg/m2 (95% CI, 1.012-1.126). Female sex was found to decrease cardiogenic shock risk by 45% (95% CI, 0.304-1.002).
The researchers noted that additional studies would be needed to "further evaluate the mechanism between ischemic time and risk factors associated with [cardiogenic shock]."
Amponsah D, Khachatryan T, Hamilton D, et al. Ischemic time and risk factors associated with the incidence of cardiogenic shock in patients presenting with ST elevation myocardial infarction. Abstract 1126-330. Presented at: 66th Annual Scientific Session & Expo of the American College of Cardiology. March 17-19, 2017; Washington, DC.