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

doi:10.1177/2048872617706503

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

Department of Clinical Medicine

22 Citations (Scopus)

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 (p_logrank < 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 language	English
Journal	European Heart Journal: Acute Cardiovascular Care
Volume	7
Issue number	1
Pages (from-to)	7-15
Number of pages	9
ISSN	2048-8726
DOIs	https://doi.org/10.1177/2048872617706503
Publication status	Published - 1 Feb 2018

Keywords

Denmark/epidemiology
Follow-Up Studies
Hospital Mortality/trends
Incidence
Patient Admission/trends
Percutaneous Coronary Intervention
Prognosis
Prospective Studies
Registries
Risk Factors
ST Elevation Myocardial Infarction/complications
Shock, Cardiogenic/epidemiology
Survival Rate/trends
Time Factors

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10.1177/2048872617706503

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Obling, L., Frydland, M., Hansen, R., Møller-Helgestad, O. K., Lindholm, M. G., Holmvang, L., Ravn, H. B., Wiberg, S., Thomsen, J. H., Jensen, L. O., Kjærgaard, J., Møller, J. E., & Hassager, C. (2018). Risk factors of late cardiogenic shock and mortality in ST-segment elevation myocardial infarction patients. European Heart Journal: Acute Cardiovascular Care, 7(1), 7-15. https://doi.org/10.1177/2048872617706503

Obling, L, Frydland, M, Hansen, R, Møller-Helgestad, OK, Lindholm, MG, Holmvang, L, Ravn, HB, Wiberg, S, Thomsen, JH, Jensen, LO, Kjærgaard, J, Møller, JE & Hassager, C 2018, 'Risk factors of late cardiogenic shock and mortality in ST-segment elevation myocardial infarction patients', European Heart Journal: Acute Cardiovascular Care, vol. 7, no. 1, pp. 7-15. https://doi.org/10.1177/2048872617706503

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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.",

keywords = "Denmark/epidemiology, Follow-Up Studies, Hospital Mortality/trends, Incidence, Patient Admission/trends, Percutaneous Coronary Intervention, Prognosis, Prospective Studies, Registries, Risk Factors, ST Elevation Myocardial Infarction/complications, Shock, Cardiogenic/epidemiology, Survival Rate/trends, Time Factors",

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",

year = "2018",

month = feb,

day = "1",

doi = "10.1177/2048872617706503",

language = "English",

volume = "7",

pages = "7--15",

journal = "European Heart Journal: Acute Cardiovascular Care",

issn = "2048-8726",

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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 - Denmark/epidemiology

KW - Follow-Up Studies

KW - Hospital Mortality/trends

KW - Incidence

KW - Patient Admission/trends

KW - Percutaneous Coronary Intervention

KW - Prognosis

KW - Prospective Studies

KW - Registries

KW - Risk Factors

KW - ST Elevation Myocardial Infarction/complications

KW - Shock, Cardiogenic/epidemiology

KW - Survival Rate/trends

KW - Time Factors

U2 - 10.1177/2048872617706503

DO - 10.1177/2048872617706503

M3 - Journal article

C2 - 28452562

SN - 2048-8726

VL - 7

SP - 7

EP - 15

JO - European Heart Journal: Acute Cardiovascular Care

JF - European Heart Journal: Acute Cardiovascular Care

IS - 1

ER -

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

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Keywords

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