In-hospital mortality in cardiogenic shock complicating a STEMI: MIRAMI registry

Abstract

Cardiogenic shock (CC) is a devastating complication of the ST elevation acute myocardial infarction (STEMI). Its mortality remains high despite the huge progress in critical care and coronary revascularization. We aim in this study to evaluate in-hospital mortality and its predicting factors in cardiogenic shock complicating a STEMI. It is a retrospective, mono-centric study including 267 patients from the MIRAMI registry who presented a CC-STEMI between 1995 and 2016. In-hospital mortality rate from all causes was 49.1% with a slight non-significant raise tendency over the study years ( P = 0.299). The major cause was primary left ventricle dysfunction (61%) and death occurred within the first 24 hours in almost half of cases (49.2%). In uni-variate analysis, in-hospital mortality was more often in autumn ( P = 0.033), among females ( P = 0.001) and in elderly ( P = 0.019). The major clinical mortality predicting factors were: hypertension ( P < 0.001), diabetes ( P = 0.003), transportation delay > 60 min ( P = 0.034), a delay from symptoms onset to hospitalization > 6 hours ( P = 0.034), anterior territory of the STEMI ( P = 0.006) and Q wave on ECG ( P = 0.043). Biological predicting factors were: anemia ( P = 0.001), renal dysfunction ( P < 0.001), hyper-uremia ( P = 0.002), hyperglycemia ( P < 0.001) and elevated necrosis biomarkers ( P = 0.04). On echography, altered LVEF ( P = 0.002) and restrictive mitral profile ( P < 0.001) were associated to a raise in death rate. Early invasive strategy did not reduce in-hospital mortality as in the SHOCK trial ( P = 0.21). In a multivariate analysis, only renal failure ( P < 0.001; OR: 3.53) and mechanical ventilation ( P < 0.001; OR: 16.19) were restrained as independent predicting factors of in-hospital mortality. In hospital mortality in CS-STEMI remains high even in literature so that the treatment strategy should be based on an urgent and multi-disciplinary approach.