Predictors of unfavorable clinical outcomes of myocardial infarction complicated cardiogenic shock: results of single center retrospective study

Abstract

The aim – to search for risk factors of adverse clinical outcome of acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). Materials and methods. In pilot retrospective study 1,292 consecutive patients with AMI treated by emergent percutaneous coronary intervention (PCI) in the reperfusion center of Zaitsev V.T. Institute for General and Emergency Surgery NAMS of Ukraine were selected. 54 out of 1292 patients (4.2 %) matched the Society for Cardiovascular Angiography and Interventions (SCAI) criteria of CS stage C and higher either on admission or during hospitalization. Results and discussion. The overall hospital mortality in patients with CS due to AMI in our series was 59.3 %. Univariant analysis revealed that the age of 65 and higher, left ventricular ejection fraction < 40 %, a single-vessel coronary lesion, absence of concomitant chronic total occlusion (CTO), reperfusion deterioration and cardiac arrest were the only risk factors for hospital death in CS patients. The risk of CS progression was independently associated with anemic syndrome (Hb < 118 g/l), chronic total occlusion, and multivessel coronary disease. In a multivariant logistic regression the preexisting LV EF < 40 %, single-vessel disease and absence of CTO were found as the independent predictors of hospital morta­­­lity in СS. Conclusions. СS in patients with AMI still be a significant challenge even after successful PCI, associated with high in-hospital mortality (59.3 %). There is an unmet need for development and implementation of an adjusted registry-based national protocol for CS management in order to improve patient survival.