Abstract 298: Incidence, Treatment and Outcomes of Cardiogenic Shock in STEMI and NSTEMI: Results from the NCDR®

Abstract

Objectives: Cardiogenic shock (CS) is a deadly complication of an acute myocardial infarction (MI). We sought to characterize the contemporary incidence, treatment, and outcomes of CS in ST and non-ST elevation (STEMI and NSTEMI) classification. Methods: We examined 235,541 patients treated at 392 ACTION Registry ® -GWTG ™ hospitals from 2007- 2011. CS was defined as sustained systolic blood pressure (SBP) <90 mmHg or cardiac index (CI) <2.2 L/min/m2 secondary to cardiac dysfunction or use of vasopressor or inotropic agents or mechanical support that occurred on admission or that developed during the hospital stay. Results: CS occurred in 12.2% (11,406 patients; 47.4% at presentation, 52.6% in-hospital) of STEMI vs 4.3% (6,130; 34.3% at presentation, 65.7% in-hospital) of NSTEMI patients. STEMI patients with CS were more likely to undergo PCI vs NSTEMI patients with CS (84.2% vs 35.4%, p<0.0001). CABG was uncommon among STEMI or NSTEMI CS patients (11.6% vs 21.2%, p<0.0001)). STEMI patients with CS had significantly lower mortality than NSTEMI patients with CS (33.1% vs. 40.8%, p<0.0001). In both STEMI and NSTEMI groups, the subsequent development of CS was associated with significantly higher mortality than CS on admission (35.1% vs 30.9%, p <0.0001 and 42.9% vs 36.8% p <0.0001, respectively). Conclusion: In the contemporary era, after ACCF/AHA Class IA guidelines endorsing early revascularization for STEMI related CS, most STEMI patients with CS undergo revascularization, and death is significantly lower in comparison to earlier pre-guideline data. However, compared to STEMI CS, a majority of NSTEMI CS patients do not undergo revascularization, and death rates are significantly higher. In-hospital development of CS carries a higher mortality rate in both MI subtypes compared to CS on admission.