RIGHT VENTRICULAR DYSFUNCTION AS A MORTALITY DETERMINANT FOR PATIENTS WITH CARDIOGENIC SHOCK INDUCED BY ACUTE MYOCARDIAL INFARCTION.

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: tricuspid annular plane systolic excursion <17 mm, S' wave <12 cm/s, and tricuspid annular plane systolic excursion/ pulmonary artery systolic pressure 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 Society for Cardiovascular Angiography and Interventions shock stage, cardiac arrest, age, non-ST-elevation myocardial infarction, number of vessels affected, and elevated creatinine, while follow-up mortality was associated with advanced Society for Cardiovascular Angiography and Interventions stage, reduced left ventricular ejection fraction, elevated blood urea nitrogen, history of CABG and comorbidities including chronic obstructive pulmonary disease and prior cerebrovascular accident.

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.