Outcomes of ST-Segment Elevation Myocardial Infarction in a Cohort of Cardiogenic Shock Patients Undergoing Primary Percutaneous Coronary Intervention

Abstract

Objectives: The objective of this study was to investigate the immediate and short-term mortality rates among patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS) who underwent primary percutaneous coronary intervention (PCI).

Methodology: This observational study was conducted at a tertiary care cardiac center in Pakistan. We included consecutive patients diagnosed with STEMI complicated by CS who underwent primary PCI. We analyzed the clinical characteristics, management strategies, and in-hospital as well as short-term follow-up outcomes of the patients.

Results: A total of 200 patients were included in the study, of which 74.5% (149) were male, and the mean age was 57.96 ± 12.52 years. The majority of patients were classified as Killip class III (64.0%, 128), while the remaining were classified as Killip class IV. On arrival, arrhythmias were observed in 37.5% (75) of the patients, 27.5% (55) were in cardiac arrest and 84.5% (169) required intubation. Intra-aortic balloon pump (IABP) placement was performed in 31.5% (63) of the patients, and temporary pacemakers (TPM) were placed in 18.5% (37). The in-hospital mortality rate was found to be 10.5% (21). During a mean follow-up period of 177 days (141.5-212.5), a cumulative major adverse cardiovascular event (MACE) was observed in 48% (96) of the patients, with an all-cause mortality rate of 28% (56). Additionally, re-infarction occurred in 7.5% (15) of the patients, and re-hospitalization due to heart failure was noted in 23.5% (47) of the patients.

Conclusion: Our study revealed an in-hospital mortality rate of 10.5% following primary PCI in patients with CS. At approximately six months after the acute event, nearly half of the patients experienced MACE, with a notable mortality rate of 28%. These findings highlight the critical nature of CS and emphasize the need for further research and interventions to improve outcomes in this high-risk patient population.