Clinical Characteristics and Outcomes of STEMI Patients With Cardiogenic Shock and Cardiac Arrest

• DOI: 10.1016/j.jcin.2020.04.004
• Publication Date: 2020-05-18T20:15:56Z
• Authors: Mohamed A. Omer; Jeffrey M. Tyler; Timothy D. Henry; Ross Garberich; Scott W. Sharkey; Christian W. Schmidt; Jason T. Henry; Peter Eckman; Michael Megaly; Emmanouil S. Bril...; Ivan Chavez; Nicholas Burke; Mario Gössl; Michael Mooney; Paul Sorajja; Jay H. Traverse; Yale Wang; Katarzyna Hryniewicz; Santiago Garcia
• Keywords: Aged, 80 and over; Male; Time Factors; Electric Countershock; Shock, Cardiogenic; Arrhythmias, Cardiac; Middle Aged; Risk Assessment; Heart Arrest; 3. Good health; 03 medical and health sciences; Percutaneous Coronary Intervention; Treatment Outcome; 0302 clinical medicine; Heart Rate; Risk Factors; Humans; ST Elevation Myocardial Infarction; Female; Hospital Mortality; Registries; Aged; Retrospective Studies

This study sought to compare the clinical characteristics and long-term outcomes of patients with ST-segment elevation myocardial infarction (STEMI) with and without cardiogenic shock (CS) or cardiac arrest (CA) before percutaneous coronary intervention (PCI).Patients with STEMI complicated by CS or CA are underrepresented in STEMI registries.Consecutive patients with STEMI or new left bundle branch block within 24 h of symptom onset were included in a regional STEMI program comprising a PCI center (Minneapolis Heart Institute at Abbott Northwestern Hospital), 11 hospitals <60 miles from PCI center (zone 1), and 19 hospitals 60 to 210 miles from PCI center (zone 2). No patients were excluded. Patients were stratified based on the presence (+) or absence (-) of CS or CA before PCI. Patients with CA were further classified based on initial rhythm. Primary outcomes were in-hospital and 5-year mortality.Between March 2003 and December 2014, 4,511 STEMI patients were included in the regional program, including 398 (9%) with CS and 499 (11%) with CA. Hospital mortality was: CS+ and CA+, 44%; CS+ and CA-, 23%; CS- and CA+, 19%; and CS- and CA-, 2% (p < 0.001). The 5-year survival probability for CS+ and CA+ patients was 0.69 (95% confidence interval: 0.61 to 0.76) and 0.89 (95% confidence interval: 0.84 to 0.93), respectively (p < 0.01). Compared with patients with shockable rhythms, CA patients with nonshockable rhythms had significantly lower odds of survival at hospital discharge and at 5 years (both p < 0.001).The combination of CS and CA significantly increases short-term mortality in patients with STEMI. After 5 years of follow-up, CS patients remained at high risk of fatal events, whereas the prognosis of CA patients was determined by initial rhythm at presentation.