Nationwide one-year outcomes in acute myocardial infarction-related cardiogenic shock with a focus on broad-anterior myocardial infarction: Insights from a Japanese registry.

BACKGROUND

The one-year prognosis for patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) undergoing percutaneous coronary intervention (PCI) has not been sufficiently characterized, particularly in nationwide registry analyses. Moreover, data comparing outcomes by infarct location, such as broad-anterior myocardial infarction (BA-MI) vs. non-BA-MI, remain scarce.

METHODS AND

RESULTS

We analyzed 2489 AMI-CS patients from the J-PCI OUTCOME registry, classifying them into BA-MI and non-BA-MI groups. BA-MI was defined as a culprit lesion in the left main trunk or proximal left anterior descending artery. One-year cumulative incidence in BA-MI vs. non-BA-MI was 16.2 % vs. 11.6 % (p = 0.002) for all-cause death, 10.9 % vs. 7.2 % (p = 0.002) for cardiac death, 5.9 % vs. 4.8 % (p = 0.32) for non-cardiac death, and 6.3 % vs. 3.6 % (p = 0.007) for heart failure hospitalization (HFH). BA-MI was independently associated with cardiac death (HR: 1.38; 95 % CI: 1.02-1.87; p = 0.04) and HFH (HR: 1.71; 95 % CI: 1.12-2.62; p = 0.01), but not with all-cause or non-cardiac death. Predictors of all-cause death included age > 80 years, diabetes, chronic kidney disease, cardiac arrest within 24 h, and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) use, including VA-ECMO alone and VA-ECMO combined with either an intra-aortic balloon pump or an Impella device (Abiomed Inc., Danvers, MA, USA). Landmark analysis demonstrated that BA-MI was associated with an increased risk of HFH during the 31-365-day follow-up period. Among patients without VA-ECMO, BA-MI was significantly associated with all-cause death (HR: 1.36; 95 % CI: 1.04-1.79; p = 0.03).

CONCLUSIONS

In AMI-CS, BA-MI was independently linked to cardiac death and HFH, and to all-cause death in patients without VA-ECMO. HFH events in the BA-MI group accumulated progressively, and the difference compared with non-BA-MI became increasingly evident during the one-year follow-up. Traditional risk factors and VA-ECMO were associated with all-cause death.