Abstract 14371: Incidence of Cardiogenic Shock in In-Hospital vs Out of Hospital ST-elevation Myocardial Infarction

Abstract

Background: Cardiogenic shock (CS) remains the most common cause of death in patients with acute myocardial infarction. We aimed to study if the incidence of CS is different in patients who develop in-hospital STEMI compared to patients admitted with out-of-hospital STEMI (Direct STEMI). Methods: All STEMI patients who underwent Percutaneous Coronary Intervention (PCI) at the Cleveland Clinic main campus between January 1, 2011, to July 15, 2019, were included in our study. Patients were classified depending on the location of STEMI into in-hospital or out of hospital (direct STEMI) and the incidence of cardiogenic shock was compared between both the groups. Results: There were a total of 1715 patients who were admitted to our hospital with STEMI from outside (direct STEMI) compared to 132 patients who developed in-hospital STEMI. Baseline characteristics were quite similar except for a higher prevalence of smoking in the direct STEMI group and a higher prevalence of prior PCI and prior heart failure in the in-hospital STEMI group. We found that 25.8% of patients with In-hospital STEMI developed cardiogenic shock whereas only 7.9% of patients with direct STEMI developed cardiogenic shock. Conclusion: Patients with in-hospital STEMI are three times more likely than direct STEMI patients to develop cardiogenic shock. Integration of therapeutic strategies around cardiogenic shock may be important in improving outcomes of this high-risk group of patients with STEMI.