Risk factors of late cardiogenic shock and mortality in ST-segment elevation myocardial infarction patients

Laust Obling, Martin Frydland, Rikke Hansen, Ole Kristian Møller-Helgestad, Matias Greve Lindholm, Lene Holmvang, Hanne Berg Ravn, Sebastian Wiberg, Jakob Hartvig Thomsen, Lisette Okkels Jensen, Jesper Kjærgaard, Jacob Eifer Møller, Christian Hassager

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

BACKGROUND: The incidence of cardiogenic shock (CS) in patients with ST-segment elevation myocardial infarction (STEMI) is as high as 10%. The majority of patients are thought to develop CS after admission (late CS), but the incidence in a contemporary STEMI cohort admitted for primary percutaneous intervention remains unknown.

AIM: The aim of this study was to assess the incidence and time of CS onset in patients with suspected STEMI admitted in two high-volume tertiary heart centres and to assess the variables associated with the development of late CS.

METHODS: We included consecutive patients admitted for acute coronary angiography with suspected STEMI in a 1-year period. Cardiogenic shock was based on clinical criteria and subdivided into patients with shock on admission, patients developing shock during catheterisation and patients developing shock later during hospitalisation. Follow-up for all-cause mortality was done using registries.

RESULTS: A total of 2247 patients with suspected STEMI were included, whereof 225 (10%) developed CS. The majority (56%) had CS on admission, 16% developed CS in the catheterisation laboratory and 28% developed late CS. Thirty-day mortality was 3.1% versus 47% in non-CS versus CS patients ( plogrank < 0.0001). Age, stroke, time from symptom onset to intervention, anterior STEMI, heart rate/systolic blood pressure ratio and being comatose after resuscitation from cardiac arrest were independently associated with the development of late CS.

CONCLUSION: In this study, 10% of patients admitted with suspected STEMI for acute coronary angiography presented with or developed CS. Most were in shock on admission. Irrespective of the timing of shock, mortality was high.

Original languageEnglish
JournalEuropean heart journal. Acute cardiovascular care
Volume7
Issue number1
Pages (from-to)7-15
ISSN2048-8726
DOIs
Publication statusPublished - 1. Feb 2018

Fingerprint

Cardiogenic Shock
Coronary Angiography
ST Elevation Myocardial Infarction
Incidence
Patient Admission
Registries

Keywords

  • Cardiogenic shock
  • mortality
  • prediction
  • prognosis
  • STEMI

Cite this

Obling, Laust ; Frydland, Martin ; Hansen, Rikke ; Møller-Helgestad, Ole Kristian ; Lindholm, Matias Greve ; Holmvang, Lene ; Ravn, Hanne Berg ; Wiberg, Sebastian ; Thomsen, Jakob Hartvig ; Jensen, Lisette Okkels ; Kjærgaard, Jesper ; Møller, Jacob Eifer ; Hassager, Christian. / Risk factors of late cardiogenic shock and mortality in ST-segment elevation myocardial infarction patients. In: European heart journal. Acute cardiovascular care. 2018 ; Vol. 7, No. 1. pp. 7-15.
@article{21577a9128ad41bda93d51d1e5f5ff51,
title = "Risk factors of late cardiogenic shock and mortality in ST-segment elevation myocardial infarction patients",
abstract = "BACKGROUND: The incidence of cardiogenic shock (CS) in patients with ST-segment elevation myocardial infarction (STEMI) is as high as 10{\%}. The majority of patients are thought to develop CS after admission (late CS), but the incidence in a contemporary STEMI cohort admitted for primary percutaneous intervention remains unknown.AIM: The aim of this study was to assess the incidence and time of CS onset in patients with suspected STEMI admitted in two high-volume tertiary heart centres and to assess the variables associated with the development of late CS.METHODS: We included consecutive patients admitted for acute coronary angiography with suspected STEMI in a 1-year period. Cardiogenic shock was based on clinical criteria and subdivided into patients with shock on admission, patients developing shock during catheterisation and patients developing shock later during hospitalisation. Follow-up for all-cause mortality was done using registries.RESULTS: A total of 2247 patients with suspected STEMI were included, whereof 225 (10{\%}) developed CS. The majority (56{\%}) had CS on admission, 16{\%} developed CS in the catheterisation laboratory and 28{\%} developed late CS. Thirty-day mortality was 3.1{\%} versus 47{\%} in non-CS versus CS patients ( plogrank < 0.0001). Age, stroke, time from symptom onset to intervention, anterior STEMI, heart rate/systolic blood pressure ratio and being comatose after resuscitation from cardiac arrest were independently associated with the development of late CS.CONCLUSION: In this study, 10{\%} of patients admitted with suspected STEMI for acute coronary angiography presented with or developed CS. Most were in shock on admission. Irrespective of the timing of shock, mortality was high.",
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author = "Laust Obling and Martin Frydland and Rikke Hansen and M{\o}ller-Helgestad, {Ole Kristian} and Lindholm, {Matias Greve} and Lene Holmvang and Ravn, {Hanne Berg} and Sebastian Wiberg and Thomsen, {Jakob Hartvig} and Jensen, {Lisette Okkels} and Jesper Kj{\ae}rgaard and M{\o}ller, {Jacob Eifer} and Christian Hassager",
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Risk factors of late cardiogenic shock and mortality in ST-segment elevation myocardial infarction patients. / Obling, Laust; Frydland, Martin; Hansen, Rikke; Møller-Helgestad, Ole Kristian; Lindholm, Matias Greve; Holmvang, Lene; Ravn, Hanne Berg; Wiberg, Sebastian; Thomsen, Jakob Hartvig; Jensen, Lisette Okkels; Kjærgaard, Jesper; Møller, Jacob Eifer; Hassager, Christian.

In: European heart journal. Acute cardiovascular care, Vol. 7, No. 1, 01.02.2018, p. 7-15.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Risk factors of late cardiogenic shock and mortality in ST-segment elevation myocardial infarction patients

AU - Obling, Laust

AU - Frydland, Martin

AU - Hansen, Rikke

AU - Møller-Helgestad, Ole Kristian

AU - Lindholm, Matias Greve

AU - Holmvang, Lene

AU - Ravn, Hanne Berg

AU - Wiberg, Sebastian

AU - Thomsen, Jakob Hartvig

AU - Jensen, Lisette Okkels

AU - Kjærgaard, Jesper

AU - Møller, Jacob Eifer

AU - Hassager, Christian

PY - 2018/2/1

Y1 - 2018/2/1

N2 - BACKGROUND: The incidence of cardiogenic shock (CS) in patients with ST-segment elevation myocardial infarction (STEMI) is as high as 10%. The majority of patients are thought to develop CS after admission (late CS), but the incidence in a contemporary STEMI cohort admitted for primary percutaneous intervention remains unknown.AIM: The aim of this study was to assess the incidence and time of CS onset in patients with suspected STEMI admitted in two high-volume tertiary heart centres and to assess the variables associated with the development of late CS.METHODS: We included consecutive patients admitted for acute coronary angiography with suspected STEMI in a 1-year period. Cardiogenic shock was based on clinical criteria and subdivided into patients with shock on admission, patients developing shock during catheterisation and patients developing shock later during hospitalisation. Follow-up for all-cause mortality was done using registries.RESULTS: A total of 2247 patients with suspected STEMI were included, whereof 225 (10%) developed CS. The majority (56%) had CS on admission, 16% developed CS in the catheterisation laboratory and 28% developed late CS. Thirty-day mortality was 3.1% versus 47% in non-CS versus CS patients ( plogrank < 0.0001). Age, stroke, time from symptom onset to intervention, anterior STEMI, heart rate/systolic blood pressure ratio and being comatose after resuscitation from cardiac arrest were independently associated with the development of late CS.CONCLUSION: In this study, 10% of patients admitted with suspected STEMI for acute coronary angiography presented with or developed CS. Most were in shock on admission. Irrespective of the timing of shock, mortality was high.

AB - BACKGROUND: The incidence of cardiogenic shock (CS) in patients with ST-segment elevation myocardial infarction (STEMI) is as high as 10%. The majority of patients are thought to develop CS after admission (late CS), but the incidence in a contemporary STEMI cohort admitted for primary percutaneous intervention remains unknown.AIM: The aim of this study was to assess the incidence and time of CS onset in patients with suspected STEMI admitted in two high-volume tertiary heart centres and to assess the variables associated with the development of late CS.METHODS: We included consecutive patients admitted for acute coronary angiography with suspected STEMI in a 1-year period. Cardiogenic shock was based on clinical criteria and subdivided into patients with shock on admission, patients developing shock during catheterisation and patients developing shock later during hospitalisation. Follow-up for all-cause mortality was done using registries.RESULTS: A total of 2247 patients with suspected STEMI were included, whereof 225 (10%) developed CS. The majority (56%) had CS on admission, 16% developed CS in the catheterisation laboratory and 28% developed late CS. Thirty-day mortality was 3.1% versus 47% in non-CS versus CS patients ( plogrank < 0.0001). Age, stroke, time from symptom onset to intervention, anterior STEMI, heart rate/systolic blood pressure ratio and being comatose after resuscitation from cardiac arrest were independently associated with the development of late CS.CONCLUSION: In this study, 10% of patients admitted with suspected STEMI for acute coronary angiography presented with or developed CS. Most were in shock on admission. Irrespective of the timing of shock, mortality was high.

KW - Cardiogenic shock

KW - mortality

KW - prediction

KW - prognosis

KW - STEMI

U2 - 10.1177/2048872617706503

DO - 10.1177/2048872617706503

M3 - Journal article

C2 - 28452562

AN - SCOPUS:85048687020

VL - 7

SP - 7

EP - 15

JO - European Heart Journal: Acute Cardiovascular Care

JF - European Heart Journal: Acute Cardiovascular Care

SN - 2048-8726

IS - 1

ER -