Risk Factors for Hospital Mortality in Acute ST-Segment Elevation Coronary Syndrome Complicated by Cardiogenic Shock

The aim. To study the risk factors for hospital mortality in patients with acute coronary syndrome with ST-segment elevation (STEACS) complicated by cardiogenic shock (CS).

Materials and methods. A total of 104 patients with STEACS complicated by CS were studied. The follow-up group (group I) included 58 (55,8%) patients who died in hospital (mean age 71,8±7,31 years), the comparison group (group II) – 46 patients, who have been treated and discharged (mean age 59,5±6,18 years). All patients underwent general clinical studies, the level of troponins, lipids, glucose, creatinine in plasma was determined, electrocardiography and echocardiography were performed. Coronary angiography and percutaneous coronary intervention (PCI) were urgently performed. The method of binary logistic regression with the determination of the odds ratio and its 95% confidence interval for each reliable variable was used to identify risk factors for hospital mortality.

Results. In group I patients with CS, compared with group II, patients over the age of 70 (32 (55,2%) vs 10 (22,7%), р=0,0004), with concomitant chronic kidney disease (32 (55,2%) vs 9 (19,6%), p=0,0002), postinfarction cardiosclerosis (30 (51,7%) vs 9 (19,6%), р=0,001) and chronic heart failure of III-IV functional class (32 (55,1%) vs 11 (23,9%), p=0,001) were significantly more often observed. Baseline levels of plasma leukocytes, troponin and creatinine were significantly higher in deceased patients with CS. Left ventricular ejection fraction below 40% was observed more often in the follow-up group than in the comparison group (46 (79,3%) vs 27 (58,7%), p=0,022). In group I, compared with group II, there was a higher incidence of three-vessel coronary lesions (36 (75%) vs 12 (26,1%), p=0,0001) and chronic coronary artery occlusion unrelated to STEACS (25 (52,1%) vs 12 (26,1%), р=0,009). The same trend was observed when assessing the average number of stenoses and occlusions of the coronary arteries. PCI was performed in 43 (74,1%) of the deceased and 43 (93,5%) of the surviving STEACS patients with CS (p=0,009). The follow-up group had a higher rate of unsuccessful PCI (30,2%) vs 3 (7%), р=0,001) and performed later than 6 hours after the onset of an angina attack (28 (65,1%) vs 6 (14%), р=0,0001).

Summary. Hospital mortality in patients with STEMI complicated by CS was associated with the presence left ventricular ejection fraction less than 40%, three-vessel coronary lesion and performing PCI later than 6 hours from the beginning of the pain attack.

1. Бойцов С.А., Акчурин Р.С., Певзнер Д.В. и др. Кардиогенный шок — современное состояние проблемы. Российский кардиологический журнал. 2019; 24(10): 126-136. DOI: 10.15829/1560-4071-2019-10-126-136 Boitsov S.A., Akchurin R.S., Pevsner D.V. et al. Cardiogenic shock — current state of the problem. Rossiyskiy kardiologicheskiy zhurnal. 2019; 24(10): 126-136. DOI: 10.15829/1560-4071-2019-10-126-136 [In Russian].

2. Anderson M.L., Peterson E.D., Peng S.A. et al. Differences in the profile, treatment and prognosis of patients with cardiogenic shock by myocardial infarction classification. A report from NCDR. Circulation: Cardiovascular Quality and Outcomes. 2013;.6:.708-715. DOI: 10.1161/CIRCOUTCOMES.113.000262.

3. Harjola V.P., Lassus J., Sionis A. et al. Clinical picture and risk prediction of short-term mortality in cardiogenic shock. European Journal of Heart Failure. 2015; 17(5): 501-509. DOI: 10.1002/ejhf.260.

4. Hosseiny D.A., Moloi S., Chandrasekhar J. et al. Mortality pattern and cause of death in a long-term follow-up of patients with STEMI treated with primary PCI. Open Heart. 2016; 3(1): e000405. DOI: 10.1136/openhrt-2016-000405.

5. Hunziker L., Radovanovic D., Jeger R. et al. Twenty-year trends in the incidence and outcome of cardiogenic shock in AMIS Plus Registry. Circulation: Cardiovascular Interventions. 2019; 12(4): 1-9. DOI: 10.1161/circinterventions.118.007293.

6. Rathod K.S., Koganti S., Iqbal M.B. et al. Contemporary trends in cardiogenic shock: Incidence, intra-aortic balloon pump utilisation and outcomes from the London Heart Attack Group. European Heart Journal: Acute Cardiovascular Care. 2017; 7(1): 16-27. DOI: 10.1177/2048872617741735.

7. Goldberg R.J., Samad N.A., Yarzebski J. et al. Temporal trends in cardiogenic shock complicating acute myocardial infarction. New England Journal of Medicine. 2019; 340(15): 1162-1168. DOI:10.1056/nejm199904153401504.

8. Wayangankar S.A., Bangalore S., McCoy L.A. et al. Temporal trends and outcomes of patients undergoing percutaneous coronary interventions for cardiogenic shock in the setting of acute myocardial infarction. JACC: Cardiovascular Interventions. 2016; 9(4): 341-351. DOI: 10.1016/j.jcin.2015.10.039.

9. Goldberg R.J., Spencer F.A., Gore J.M. et al. Thirty-year trends (1975 to 2005) in the magnitude of, management of and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: a population-based perspective. Circulation. 2009; 119(9): 1211-1219. DOI: 10.1161/CIRCULATIONAHA.108.814947.

10. Aissaoui N., Puymirat E., Tabone X. et al. Improved outcome of cardiogenic shock at the acute stage of myocardial infarction: a report from the USIK 1995, USIC 2000, and FAST-MI French Nationwide Registries. Eur Heart J. 2012; 33: 2535-2543. DOI: 10.1093/eurheartj/ehs264.

11. Fengler K., Fuernau G., Desch S. et al. Gender differences in patients with cardiogenic shock complicating myocardial infarction: a substudy of the IABP-SHOCK II-trial. Clin Res Cardiol. 2015; 104: 71-78. DOI: 10.1007/s00392-014-0767-2.

12. Hashmi K.A., Abbas K., Hashmi A.A. et al. In-hospital mortality of patients with cardiogenic shock after acute myocardial infarction; impact of early revascularization. BMC Res Notes. 2018; 11: 721. DOI: 10.1186/s13104-018-3830-7.

13. Wong S.C., Sleeper L.A., Monrad E.S. et al. Absence of gender differences in clinical outcomes in patients with cardiogenic shock complicating acute myocardial infarction. A report from the SHOCK Trial Registry. J Am Coll Cardiol. 2001; 38(5): 1395-1401. DOI: 10.1016/S0735-1097(01)01581-9.

14. Fuernau G., Poenisch C., Eitel I. et al. Prognostic impact of established and novel renal function biomarkers in myocardial infarction with cardiogenic shock: A biomarker substudy of the IABP-SHOCK II-trial. Int J Cardiol. 2015; 191: 159-166. DOI: 10.1016/j.ijcard.2015.04.242.

15. Hochman J.S., Buller C.E., Sleeper L.A. et al. Cardiogenic shock complicating acute myocardial infarction — etiologies, management and outcome: a report from the SHOCK Trial Registry. Journal of the American College of Cardiology. 2000; 36(3): 1063-1070 DOI: 10.1016/S0735-1097(00)00879-2.

16. Reynolds H.R., Hochman J.S. Cardiogenic shock. Current concepts and improving outcomes. Circulation. 2008; 117: 686-697. DOI: 10.1161/CIRCULATIONAHA.106.613596.

17. Patel M.R., Mahaffey K.W., Armstrong P.W. et al. Prognostic usefulness of white blood cell count and temperature in acute myocardial infarction (from the CARDINAL Trial). J Am Coll Cardiol. 2005; 95: 614-618. DOI: 10.1016/j.amjcard.2004.11.008.

18. Jolly S.S., Shenkman H., Brieger D. et al. Quantitative troponin and death, cardiogenic shock, cardiac arrest and new heart failure in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS): insights from the Global Registry of Acute Coronary Events. Heart. 2011; 97: 197-202. DOI: 10.1136/hrt.2010.195511.

19. Hoebers L.P., Vis M.M., Claessen B.E. et al. The impact of multivessel disease with and without a co-existing chronic total occlusion on short- and long-term mortality in ST-elevation myocardial infarction patients with and without cardiogenic shock. Eur J Heart Fail. 2013; 15: 425-432. DOI: 10.1093/eurjhf/hfs182.