Treatment Intensity for the Management of Cardiogenic Shock: Comparison Between STEMI and Non-STEMI.
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Sinha Shashank S, Pahuja Mohit, Kataria Rachna, Blumer Vanessa, Hernandez-Montfort Jaime, Kanwar Manreet, Garan A Reshad, Zhang Yijing, Marbach Jeffrey A, Khalif Adnan, Vallabhajosyula Saraschandra, Nathan Sandeep, Abraham Jacob, Li Borui, Thayer Katherine L, Baca Paulina, Dieng Fatou, Harwani Neil M, Yin Michael Y, Faugno Anthony J, Faraz Haroon A, Guglin Maya, Hickey Gavin W, Wencker Detlef, Hall Shelley, Schwartzman Andrew D, Khalife Wissam, Li Song, Mahr Claudius, Kim Ju H, Bhimaraj Arvind, Ton Van-Khue, Vorovich Esther, Burkhoff Daniel, Kapur Navin K
Аннотация
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.