Non-STEMI vs. STEMI Cardiogenic Shock: Clinical Profile and Long-Term Outcomes
Por:
Martinez, MJ, Rueda, F, Labata, C, Oliveras, T, Montero, S, Ferrer, M, El Ouaddi, N, Serra, J, Lupon, J, Bayes-Genis, A and Garcia-Garcia, C
Publicada:
1 jun 2022
Resumen:
Cardiogenic shock (CS) is a severe complication of acute myocardial infarction (AMI). In AMI-CS, the ST segment deviation on ECG may be elevated (STEMI-CS) or non-elevated (NSTEMI-CS), which may influence prognosis. Our aim was to analyze the clinical profile, acute-phase prognosis, and long-term outcomes of CS relative to the ST pattern on admission. In a prospective registry of 4647 AMI patients admitted to the intensive cardiac care unit of a university hospital between 2010 and 2019, we compared the clinical characteristics, 30-days case fatality, and long-term outcomes of AMI-CS, based on the presence of ST-segment deviation. AMI-CS developed in 239 (5.1%) patients (26.4% women): 190 (79.5%) STEMI-CS and 49 (20.5%) NSTEMI-CS. The mean age was 69.7 years. The STEMI-CS patients had larger infarcts and more mechanical complications than the NSTEMI-CS patients. The NSTEMI-CS patients had a greater prevalence of hypertension, diabetes, peripheral vascular disease, previous cardiovascular comorbidities, three-vessel disease, and left main disease than the STEMI-CS patients. The STEMI-CS patients had higher 30-day mortality than the NSTEMI-CS (59.5% vs. 36.7%; p = 0.004), even after multivariable adjustment (HR 1.91; 95% CI 1.16-3.14), but no differences in mortality were observed at 3 years. In conclusion, the 30-day case-fatality is higher in STEMI-CS, but the long-term outcome is similar in both groups.
Filiaciones:
:
Hosp Badalona Germans Trias & Pujol, Heart Inst, Cardiol Dept, Badalona 08916, Spain
Hosp Mar, Cardiol Dept, Barcelona 08003, Spain
Autonomous Univ Barcelona, Dept Med, PhD Program, Barcelona 08193, Spain
:
Hosp Badalona Germans Trias & Pujol, Heart Inst, Cardiol Dept, Badalona 08916, Spain
Labata, C:
Hosp Badalona Germans Trias & Pujol, Heart Inst, Cardiol Dept, Badalona 08916, Spain
:
Hosp Badalona Germans Trias & Pujol, Heart Inst, Cardiol Dept, Badalona 08916, Spain
:
Hosp Badalona Germans Trias & Pujol, Heart Inst, Cardiol Dept, Badalona 08916, Spain
:
Hosp Badalona Germans Trias & Pujol, Heart Inst, Cardiol Dept, Badalona 08916, Spain
:
Hosp Badalona Germans Trias & Pujol, Heart Inst, Cardiol Dept, Badalona 08916, Spain
:
Hosp Badalona Germans Trias & Pujol, Heart Inst, Cardiol Dept, Badalona 08916, Spain
:
Hosp Badalona Germans Trias & Pujol, Heart Inst, Cardiol Dept, Badalona 08916, Spain
CIBER Enfermedades Cardiovasc CIBERCV, Madrid 28029, Spain
Autonomous Univ Barcelona, Dept Med, Barcelona 08193, Spain
:
Hosp Badalona Germans Trias & Pujol, Heart Inst, Cardiol Dept, Badalona 08916, Spain
CIBER Enfermedades Cardiovasc CIBERCV, Madrid 28029, Spain
Autonomous Univ Barcelona, Dept Med, Barcelona 08193, Spain
:
Hosp Badalona Germans Trias & Pujol, Heart Inst, Cardiol Dept, Badalona 08916, Spain
CIBER Enfermedades Cardiovasc CIBERCV, Madrid 28029, Spain
Autonomous Univ Barcelona, Dept Med, Barcelona 08193, Spain
gold, Green Published
|