Predictors of in hospital mortality in cardiogenic shock following ST-elevation myocardial infarction (STEMI)

Abbas  Andishmand; Fahimah  Kalantari

doi:10.18502/cbj.v4i2.17795

Abbas Andishmand Yazd Cardiovascular Research Center, Non- communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Fahimah Kalantari Yazd Cardiovascular Research Center, Non- communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

DOI: https://doi.org/10.18502/cbj.v4i2.17795

Keywords: Cardiogenic shock, Shock, Myocardial infarction, STEMI, LVEF, mortality

Abstract

Objectives: Cardiogenic shock (CS) is a severe complication of ST-Elevation Myocardial Infarction (STEMI) and is associated with high mortality rates. This study aimed to identify predictors of in-hospital mortality in patients experiencing cardiogenic shock following STEMI.

Methods: A retrospective cohort study was conducted at Afshar Hospital in Yazd from 2018 to 2023, analyzing clinical data from 62 STEMI patients diagnosed with CS. The mean age of the cohort was 64.9 ± 13.5 years, with a male predominance of 69.5%. Key variables assessed included left ventricular ejection fraction (LVEF), comorbidities, and treatment interventions. Survival analysis and Cox regression were employed to evaluate mortality outcomes.

Results: LVEF less than 30% emerged as a significant predictor of in-hospital mortality, with a hazard ratio of 11.1 (95% CI: 2.6–47.4; p < 0.001). The mean survival time was 7.0 days (95% CI: 5.8–8.3). Additionally, hyperlipidemia was associated with increased mortality, presenting an odds ratio of 11.3 (95% CI: 1.1–114.1; p = 0.040). The prevalence of chronic kidney disease was notably higher in the deceased cohort (28.0% vs. 8.1%; p = 0.042). Although urgent percutaneous coronary intervention (PCI) was performed in the majority of cases, mortality remained significant.

Conclusions: This study highlights that LVEF and hyperlipidemia are critical predictors of in-hospital mortality in patients with cardiogenic shock following STEMI. Other studies also suggest the prognostic value of LVEF in various cardiac conditions, particularly in the context of acute coronary syndromes [14, 15]. Also, the combination of renal dysfunction left ventricular ejection fraction, and advanced age has been proposed as a predictor of in-hospital mortality [18]. These findings underscore the importance of early identification and targeted management strategies to improve patient outcomes in this high-risk population.