Right ventricular dysfunction as a mortality determinant for patients with cardiogenic shock induced by acute myocardial infarction.

Abstract

Background: Cardiogenic shock (CS) secondary to acute myocardial infarction (AMI) is a major cause of in-hospital mortality. With the addition of right ventricular dysfunction (RVD), it is associated with poorer outcomes. This study examines the impact of RVD on mortality in CS-AMI patients, highlighting the importance of early RVD identification and tailored management.

Methods: Data from the Gulf Cardiogenic Shock (Gulf-CS) registry-a multicenter registry of CS-AMI patients from six Gulf countries-were analyzed to compare in-hospital and long-term outcomes for patients with and without RVD. RVD was defined by echocardiographic criteria: TAPSE <17 mm, S' wave <12 cm/s, and TAPSE/PASP ratio < 0.34. Multivariable logistic and Cox regression models were used to identify in-hospital and follow-up mortality predictors.

Results: Among 1,513 CS-AMI patients, RVD was independently associated with higher in-hospital mortality (55.87% vs. 42.89%, p < 0.001) and lower survival at 6, 12, 18, and 24 months (58%, 35%, 18%, and 6% vs. 73%, 53%, 38%, and 30%; p < 0.001). Predictors of in-hospital mortality included advanced SCAI shock stage, cardiac arrest, age, NSTEMI, number of vessels affected, and elevated creatinine, while follow-up mortality was associated with advanced SCAI stage, reduced LVEF, elevated BUN, history of CABG and comorbidities including COPD and prior CVA.

Conclusion: RVD is a significant independent predictor of both in-hospital and long-term mortality in CS-AMI, highlighting the need for early RVD assessment and specific interventions. This study's findings support the integration of RV-focused management strategies to improve survival outcomes in this high-risk population.