TY - JOUR
T1 - Treatment Intensity for the Management of Cardiogenic Shock
T2 - Comparison Between STEMI and Non-STEMI
AU - Sinha, Shashank S.
AU - Pahuja, Mohit
AU - Kataria, Rachna
AU - Blumer, Vanessa
AU - Hernandez-Montfort, Jaime
AU - Kanwar, Manreet
AU - Garan, A. Reshad
AU - Zhang, Yijing
AU - Marbach, Jeffrey A.
AU - Khalif, Adnan
AU - Vallabhajosyula, Saraschandra
AU - Nathan, Sandeep
AU - Abraham, Jacob
AU - Li, Borui
AU - Thayer, Katherine L.
AU - Baca, Paulina
AU - Dieng, Fatou
AU - Harwani, Neil M.
AU - Yin, Michael Y.
AU - Faugno, Anthony J.
AU - Faraz, Haroon A.
AU - Guglin, Maya
AU - Hickey, Gavin W.
AU - Wencker, Detlef
AU - Hall, Shelley
AU - Schwartzman, Andrew D.
AU - Khalife, Wissam
AU - Li, Song
AU - Mahr, Claudius
AU - Kim, Ju H.
AU - Bhimaraj, Arvind
AU - Ton, Van Khue
AU - Vorovich, Esther
AU - Burkhoff, Daniel
AU - Kapur, Navin K.
N1 - Publisher Copyright:
© 2023 The Authors
PY - 2023/5
Y1 - 2023/5
N2 - Background: Cardiogenic shock is a leading cause of mortality in patients with acute myocardial infarction. Objectives: The authors sought to compare clinical characteristics, hospital trajectory, and drug and device use between patients with ST-segment elevation myocardial infarction-related cardiogenic shock (STEMI-CS) and those without (non-ST-segment elevation myocardial infarction complicated by cardiogenic shock [NSTEMI-CS]). Methods: We analyzed data from 1,110 adult admissions with cardiogenic shock complicating acute myocardial infarction (AMI-CS) across 17 centers within Cardiogenic Shock Working Group. The primary end point was in-hospital mortality. Results: Our study included 1,110 patients with AMI-CS, of which 731 (65.8%) had STEMI-CS and 379 (34.2%) had NSTEMI-CS. Most patients were male (STEMI-CS: 71.6%, NSTEMI-CS: 66.5%) and White (STEMI-CS: 53.8%, NSTEMI-CS: 64.1%). In-hospital mortality was 41% and was similar among patients with STEMI-CS and NSTEMI-CS (43% vs 39%, P = 0.23). Patients with out-of-hospital cardiac arrest had higher in-hospital mortality in patients with NSTEMI-CS (63% vs 36%, P = 0.006) as compared to patients with STEMI-CS (52% vs 41%, P = 0.16). Similar results were observed for in-hospital cardiac arrest in patients with STEMI-CS (63% vs 33%, P < 0.001) and NSTEMI-CS (60% vs 32%, P < 0.001). Only 27% of patients with STEMI-CS and 12% of NSTEMI-CS received both a drug and temporary mechanical circulatory support device during the first 24 hours, which increased to 78% and 61%, respectively, throughout the course of the hospitalization (P < 0.001 for both). Conclusions: Despite increasing use of inotropic and vasoactive support and mechanical circulatory support throughout the hospitalization, both patients with STEMI-CS and NSTEMI-CS remain at increased risk for in-hospital mortality. Randomized controls trials are needed to elucidate whether timing and sequence of escalation of support improves outcomes in patients with AMI-CS.
AB - Background: Cardiogenic shock is a leading cause of mortality in patients with acute myocardial infarction. Objectives: The authors sought to compare clinical characteristics, hospital trajectory, and drug and device use between patients with ST-segment elevation myocardial infarction-related cardiogenic shock (STEMI-CS) and those without (non-ST-segment elevation myocardial infarction complicated by cardiogenic shock [NSTEMI-CS]). Methods: We analyzed data from 1,110 adult admissions with cardiogenic shock complicating acute myocardial infarction (AMI-CS) across 17 centers within Cardiogenic Shock Working Group. The primary end point was in-hospital mortality. Results: Our study included 1,110 patients with AMI-CS, of which 731 (65.8%) had STEMI-CS and 379 (34.2%) had NSTEMI-CS. Most patients were male (STEMI-CS: 71.6%, NSTEMI-CS: 66.5%) and White (STEMI-CS: 53.8%, NSTEMI-CS: 64.1%). In-hospital mortality was 41% and was similar among patients with STEMI-CS and NSTEMI-CS (43% vs 39%, P = 0.23). Patients with out-of-hospital cardiac arrest had higher in-hospital mortality in patients with NSTEMI-CS (63% vs 36%, P = 0.006) as compared to patients with STEMI-CS (52% vs 41%, P = 0.16). Similar results were observed for in-hospital cardiac arrest in patients with STEMI-CS (63% vs 33%, P < 0.001) and NSTEMI-CS (60% vs 32%, P < 0.001). Only 27% of patients with STEMI-CS and 12% of NSTEMI-CS received both a drug and temporary mechanical circulatory support device during the first 24 hours, which increased to 78% and 61%, respectively, throughout the course of the hospitalization (P < 0.001 for both). Conclusions: Despite increasing use of inotropic and vasoactive support and mechanical circulatory support throughout the hospitalization, both patients with STEMI-CS and NSTEMI-CS remain at increased risk for in-hospital mortality. Randomized controls trials are needed to elucidate whether timing and sequence of escalation of support improves outcomes in patients with AMI-CS.
KW - acute myocardial infarction
KW - cardiogenic shock
KW - heart failure
UR - http://www.scopus.com/inward/record.url?scp=85180251405&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85180251405&partnerID=8YFLogxK
U2 - 10.1016/j.jacadv.2023.100314
DO - 10.1016/j.jacadv.2023.100314
M3 - Article
C2 - 38939594
AN - SCOPUS:85180251405
SN - 2772-963X
VL - 2
JO - JACC: Advances
JF - JACC: Advances
IS - 3
M1 - 100314
ER -