0221 : Cardiogenic shock mechanism complicating STEMI and its impact on the prognosis: about 126 cases

Abstract

Cardiogenic shock is the expression of an acute and severe dysfunction of cardiac pump causing a deep alteration of peripheral perfusion and progressive tissue anoxia. Studying the mechanisms of cardiogenic shock complicating STEMI, hospitalized in our department and their impact on prognosis. A retrospective and descriptive study, conducted from medical observations of patients hospitalized with myocardial infarction, complicated by cardiogenic shock between April 2010 and June 2015. 126 patients were collected, the average age of our patients was 62.67±12.09 years. A male predominance was observed with a sex ratio of 5/1. 38.1% of the population were diabetics, 9.5% had a history of myocardial infarction. 5 patients had previous left ventricular dysfunction on echocardiography. The admission average delay was 9 hours and 24 minutes. The average time for installation of shock over the myocardial infarction was 12.5±13.53 hours. Over half of the patients were already under vasoactive drugs to their admission. A quarter of patients was stable at admission and secondarily had presented a delayed shock. The mean ejection fraction 37.26±17.10%. The extent myocardial ischemia was the most frequent shock mechanism (69%). Mechanical complications accounted for 21.4% of cases. The angioplasty was realized in 77% of cases, thrombolysis in 11.1% of cases and a surgical treatment in 11.9% of cases. Overall mortality was 72.6%. The mortality rate of patients with mechanical complication was 88.9% versus 69.9% in the extensive myocardial ischemia group and 80% in the group extension to the right ventricle. No significant difference was observed between the different mechanisms (p=0.250). Cardiogenic shock complicating STEMI is a poor prognosis with a high mortality rate, independently of the pathophysiological mechanism. The author hereby declares no conflict of interest