Background: Cardiogenic Shock (CS) remains the most common cause of death in hospitalized acute ST-segment
elevation myocardial infarction (STEMI) patients. Predictors of outcomes in those patients include clinical, laboratory,
radiologic variables, and management strategies. The present study aimed to evaluate the incidence, characteristics,
predictors of cardiogenic shock and mortality among acute ST-segment elevation myocardial infarction patients in our
center.
Methods: This was a retrospective, single-center study conducted at KAMC, Makkah during 2015e2020. All acute STsegment
elevation myocardial infarction patients during this era were divided into two groups CS group and non-CS
group.
Results: In this study total 3074 acute ST-segment elevation myocardial infarction patients of which 132(4.3%) patients
had CS. CS group tended to have higher ages than non-CS group. Pilgrims were more complicated by CS than nonpilgrims.
Subsequently, CS patients had a highly significant (p < 0.001 for all) increase in the incidence of in-hospital
complications including pulmonary oedema, cardiac arrest and ventilation. There was a significant increase in hospital
stay length and in-hospital mortality among CS patients. Renal impairment, peak troponin level, haemoglobin
drop≥3 gm/dl, and Left ventricular ejection fraction (EF) were significant independent predictors of cardiogenic shock
among our patients. However, STEMI type, left main disease, and EF was the independent predictors of CS among our
patients with diabetes with EF cut-off value of 35% with a sensitivity of 74.6% and a specificity of 65.3%. Age was the
only independent predictor of mortality among CS patients. Though age, female gender, and diabetes were found to be
the independent predictors for in-hospital mortality among our patients.
Conclusion: High-income middle eastern countries have comparable outcomes to Europe and USA among patients with
acute ST-segment elevation myocardial infarction patients with higher improvement of medical care in the last 2 to 3
decades. Renal impairment, peak troponin, severe bleeding and ejection fraction were significant independent predictors
of CS in acute ST-segment elevation myocardial infarction patients. However, STEMI type, left main disease, and
ejection fraction were the independent predictors of CS in acute ST-segment elevation myocardial infarction patients
with diabetes. Age was the only independent predictor of mortality among CS patients. |
