Heart Failure Cardiogenic Shock Research Articles

Exploring the utility of the CSWG SCAI classification in patients with HF-CS requiring inotropic therapy

Abstract Funding Acknowledgements None. Background The Society for Cardiovascular Angiography and Interventions (SCAI) classification has been a well-established tool for risk stratification in heart failure cardiogenic shock (HF-CS). The recent CSWG SCAI classification provides easily obtainable parameters to classify CS severity. However, its utility has been mostly investigated in an intensive care unit (ICU) setting. Therefore, data on a more broad cohort of patients in whom inotropic therapy is deemed necessary is lacking. Purpose This study aimed to analyze the trajectory of patients necessitating inotropic therapy due to HF-CS and the utility of the proposed CSWG SCAI criteria in time. Methods We retrospectively analyzed patients admitted with acute HF who received inotropic therapy due to developing HF-CS at any time during admission. Patients with out-of-hospital cardiac arrest and acute coronary syndrome were excluded. SCAI stages were assigned retrospectively using the latest CSWG SCAI criteria during admission, pre-inotropic therapy, and at worst SCAI. The diagnostic performance of the CSWG SCAI criteria for predicting mortality during admission was assessed. Results This study included 333 patients with HF-CS. Of these patients, 221 (66%) were male, with a mean age of 70 years. The majority of patients were admitted with SCAI A (45%) and B (36%), and inotropic therapy was most often initiated in SCAI stage B (46%). Notably, 21% patient of the patients at time of inotropic therapy were still in SCAI A. In 52% of all patients inotropes was initiated within 24 hours of admission. The most frequently observed worst SCAI classification was C (41%). Lactate and blood pressure (BP) were responsible for the majority of SCAI B-D classifications at admission and pre-inotropic therapy, while pH was an important determent for SCAI E. However, vasoactive therapy was the most common determent for worst SCAI (71%), followed by BP (24%). Mortality rates for pre-inotropic therapy SCAI for classes A-E were 30%, 39%, 47%, 55%, and 48%. Mortality rates for worst SCAI C-E were 29%, 39%, and 59%. The area under the curve for predicting mortality was higher for worst SCAI as compared to pre-inotropic therapy SCAI (0.633 vs. 0.573, p=0.03). There was no difference in mortality between early (<24h) vs. late (>24h) initiation of inotropic therapy (p=0.43). Conclusion In our study the CSWG SCAI criteria proved to be challenging to apply in patients in whom inotropic therapy is considered, especially for patients classified as SCAI E. However, improvement of the CSWG SCAI performance was observed when it was applied at the time corresponding to the worst SCAI stage to predict mortality. More studies are required to further optimize the SCAI criteria in this specific subset of patients. In summary, our study provides valuable insights into the application of the CSWG SCAI classification in a diverse HF-CS population, specifically those requiring inotropic therapy.

Serial invasive hemodynamics and clinical characteristics of patients with shock with and without invasive mechanical ventilation

Abstract Funding Acknowledgements None. Background Invasive mechanical ventilation (IMV) is commonly used in the Cardiac Intensive Care Unit (CICU) in patients with cardiogenic shock (CS). IMV causes hemodynamic changes that may impact outcomes based upon a patient’s profile. Our aim is to characterize the clinical profile and detailed serial hemodynamic parameters in the first 24-hours according to the use of IMV in patients with shock admitted to the CICU. Methods Retrospective analysis of consecutive patients with shock admitted to the CICU at Bellevue Hospital, undergoing pulmonary artery catheter (PAC) placement within the first 24 hours of admission, from February 2022 to June 2023. Clinical characteristics, as well as specific hemodynamic parameters collected and curated at times 0, 6, 12, 18 and 24 hours were from PAC placement compared between patients with and without IMV. Results A total of 101 patients were included (95% with cardiogenic shock), 59 receiving IMV (age 64 ± 15, 24% women) and 42 non-intubated (61 ± 13, 33% women). Non-intubated patients had higher prevalence of hypertension, prior coronary artery disease and heart failure with reduced ejection fraction (HFrEF), while acute coronary syndromes (44%) and cardiac arrest (12%) were more common causes of admission in patients undergoing IMV. Mixed shock predominated in IMV patients (51 vs 17%, p <0.001), whereas cardiogenic shock (CS) was more common in non-intubated patients (83 vs 41%, p <0.01). Patients with acute myocardial infarction CS (AMI-CS) were more likely to undergo IMV, while patients with heart failure CS (HF-CS) were more likely to be non-intubated. Patients undergoing IMV were more likely to have mechanical circulatory support (MCS) and ventricular dilatation compared to non-intubated patients (LVEDD 5.7 cm vs 4.9 cm, p 0.002). Patients undergoing IMV had a higher incidence of severe shock compared to the non-intubated group (31% vs 19% SCAI Shock D), higher lactate levels and greater use of vasoactive drugs (figure 1A). Patients undergoing IMV had significant improvements in cardiac power output (CPO), diastolic blood pressure and systemic vascular resistance (SVR) (figure 1B). Shock severity by SCAI SHOCK classification had a more notable improvement at 24 hours in patients with IMV compared to non-intubated patients (figure 1C), with a non-statistically significant improvement in lactate clearance in the first 24 hours (Figure 1D). Conclusions IMV in patients with CS is more commonly seen in patients with AMI-CS and among those with higher baseline shock severity and greater use of vasoactive medications. IMV is associated with significant improvements in shock severity, CPO and SVR at 24 hours when compared to patients with shock who are not intubated, which could be related to higher use of vasopressors. Further investigations are warranted to understand the impact of IMV on outcomes of patients with CS and how they might vary according to hemodynamic profile.

Pulmonary artery elastance as a predictor of hospital mortality in heart failure cardiogenic shock.

The initial bundle of cares strongly affects haemodynamics and outcomes in acute decompensated heart failure cardiogenic shock (ADHF-CS). We sought to characterize whether 24h haemodynamic profiling provides superior prognostic information as compared with admission assessment and which haemodynamic parameters best predict in-hospital death. All patients with ADHF-CS and with available admission and 24h invasive haemodynamic assessment from two academic institutions were considered for this study. The primary endpoint was in-hospital death. Regression analyses were run to identify relevant predictors of study outcome. We included 127 ADHF-CS patients [65 (inter-quartile range 52-72) years, 25.2% female]. Overall, in-hospital mortality occurred in 26.8%. Non-survivors were older, with greater CS severity. Among admission variables, age [odds ratio (OR)=1.06; 95% confidence interval (CI): 1.02-1.11; Padj=0.005] and CPIRAP (OR=0.62 for 0.1 increment; 95% CI: 0.39-0.95; Padj=0.034) were found significantly associated with in-hospital death. Among 24h haemodynamic univariate predictors of in-hospital death, pulmonary elastance (PaE) was the strongest (area under the curve of 0.77; 95% CI: 0.68-0.86). PaE (OR=5.98; 95% CI: 2.29-17.48; Padj<0.001), pulmonary artery pulsatility index (PAPi, OR=0.77; 95% CI: 0.62-0.92; Padj=0.013) and age (OR=1.06; 95% CI: 1.02-1.11; Padj=0.010) were independently associated with in-hospital death. Best cut-off for PaE was 0.85mmHg/mL and for PAPi was 2.95; cohort phenotyping based on these PaE and PAPi thresholds further increased in-hospital death risk stratification; patients with 24h high PaE and low PAPi exhibited the highest in-hospital mortality (56.2%). Pulmonary artery elastance has been found to be the most powerful 24h haemodynamic predictor of in-hospital death in patients with ADHF-CS. Age, 24h PaE, and PAPi are independently associated with hospital mortality. PaE captures right ventriclar (RV) afterload mismatch and PAPi provides a metric of RV adaptation, thus their combination generates four distinct haemodynamic phenotypes, enhancing in-hospital death risk stratification.

The management of heart failure cardiogenic shock: an international RAND appropriateness panel

BackgroundObservational data suggest that the subset of patients with heart failure related CS (HF-CS) now predominate critical care admissions for CS. There are no dedicated HF-CS randomised control trials completed to date which reliably inform clinical practice or clinical guidelines. We sought to identify aspects of HF-CS care where both consensus and uncertainty may exist to guide clinical practice and future clinical trial design, with a specific focus on HF-CS due to acute decompensated chronic HF.MethodsA 16-person multi-disciplinary panel comprising of international experts was assembled. A modified RAND/University of California, Los Angeles, appropriateness methodology was used. A survey comprising of 34 statements was completed. Participants anonymously rated the appropriateness of each statement on a scale of 1 to 9 (1–3 as inappropriate, 4–6 as uncertain and as 7–9 appropriate).ResultsOf the 34 statements, 20 were rated as appropriate and 14 were rated as inappropriate. Uncertainty existed across all three domains: the initial assessment and management of HF-CS; escalation to temporary Mechanical Circulatory Support (tMCS); and weaning from tMCS in HF-CS. Significant disagreement between experts (deemed present when the disagreement index exceeded 1) was only identified when deliberating the utility of thoracic ultrasound in the immediate management of HF-CS.ConclusionThis study has highlighted several areas of practice where large-scale prospective registries and clinical trials in the HF-CS population are urgently needed to reliably inform clinical practice and the synthesis of future societal HF-CS guidelines.

Heart failure-cardiogenic shock: A need for time-dependent quality indicators.

Heart failure-cardiogenic shock: A need for time-dependent quality indicators.

C30 24–HOUR PULMONARY ARTERY ELASTANCE IS THE STRONGEST HEMODYNAMIC PREDICTOR OF IN–HOSPITAL MORTALITY IN ACUTE DECOMPENSATED HEART FAILURE–RELATED CARDIOGENIC SHOCK

Abstract Aim The initial bundle of cares strongly affects hemodynamics in acute decompensated heart failure cardiogenic shock (ADHF–CS). We sought to characterize whether 24–hour hemodynamic profiling provides superior prognostic information as compared to admission assessment, and which hemodynamic parameters best predict in–hospital death. Methods and results We included 99 patients (62±14 years, 24.2% females) with ADHF–CS and available admission and 24–hour invasive hemodynamic assessment from two academic institutions. Overall, in–hospital mortality was 28.3%. In the admission multivariable model, age (OR=1.08; 95%CI 1.03–1.13; padj=0.002) and CPIRAP (OR=0.62; 95%CI 0.39–0.90; padj=0.022) were significantly associated with in–hospital death. Among several 24–hour hemodynamic univariate predictors of in–hospital death, pulmonary artery elastance (PaE) was the strongest (AUC 0.73; 95%CI 0.66–0.86). At 24–hours, PaE (OR=5.86; 95%CI 1.87–18.50; padj=0.003), PAPi (OR=0.75; 95%CI 0.55–0.92; padj=0.023) and age (OR=1.08; 95%CI 0.1.03–0.1.14; padj=0.005) were independently associated with in–hospital death. This 24–hour model outperformed admission model (AUC 0.85 [0.76–0.93] vs AUC 0.77 [0.67–0.88]; Figure 1). Patients were then grouped according to the optimal cutpoints of PaE 1.11 mmHg/mL and PAPi 2.12. Patients with high 24–hour PaE exhibited the highest in–hospital mortality at either low and high PAPi. The “high PAPi–low PaE” group had best parameter of (bi)ventricular function and lowest right and left filling pressures; the “low PAPi–low PaE” group exhibited parameters of poor RV function and high RAP (prevalent RV dysfunction); the “high PAPi–high PaE” group had signs of LV dysfunction coupled with parameters of relatively preserved RV function (compensated RV afterload mismatch); finally, the “low PAPi–high PaE” group exhibited worse parameters of LV and RV functions, coupled with high degree of pulmonary circulation overload and high biventricular filling pressures (decompensated RV afterload mismatch). We observed a different mortality in the cohorts identified by this classification (13.5 vs 25.0 vs 50.0 vs 43.8%; p=0.016, Figure 2). Conclusion PaE was the most powerful 24–hour hemodynamic predictor of in–hospital death in ADHF–CS. This index, coupled with PAPi, may identify patients with RV afterload mismatch and was independently associated with hospital mortality event after adjustment for multiple clinically relevant variables.

Pulmonary Artery Catheter Use and Risk of In-hospital Death in Heart Failure Cardiogenic Shock

BackgroundPulmonary artery catheters (PACs) are increasingly used to guide management decisions in cardiogenic shock (CS). The goal of this study was to determine if PAC use was associated with a lower risk of in-hospital mortality in CS owing to acute heart failure (HF-CS). Methods and ResultsThis multicenter, retrospective, observational study included patients with CS hospitalized between 2019 and 2021 at 15 US hospitals participating in the Cardiogenic Shock Working Group registry. The primary end point was in-hospital mortality. Inverse probability of treatment-weighted logistic regression models were used to estimate odds ratios (ORs) and corresponding 95% confidence intervals (CI), accounting for multiple variables at admission. The association between the timing of PAC placement and in-hospital death was also analyzed. A total of 1055 patients with HF-CS were included, of whom 834 (79%) received a PAC during their hospitalization. In-hospital mortality risk for the cohort was 24.7% (n = 261). PAC use was associated with lower adjusted in-hospital mortality risk (22.2% vs 29.8%, OR 0.68, 95% CI 0.50–0.94). Similar associations were found across SCAI stages of shock, both at admission and at maximum SCAI stage during hospitalization. Early PAC use (≤6 hours of admission) was observed in 220 PAC recipients (26%) and associated with a lower adjusted risk of in-hospital mortality compared with delayed (≥48 hours) or no PAC use (17.3% vs 27.7%, OR 0.54, 95% CI 0.37–0.81). ConclusionsThis observational study supports PAC use, because it was associated with decreased in-hospital mortality in HF-CS, especially if performed within 6 hours of hospital admission. Condensed AbstractAn observational study from the Cardiogenic Shock Working Group registry of 1055 patients with HF-CS showed that pulmonary artery catheter (PAC) use was associated with a lower adjusted in-hospital mortality risk (22.2% vs 29.8%, odds ratio 0.68, 95% confidence interval 0.50–0.94) compared with outcomes in patients managed without PAC. Early PAC use (≤6 hours of admission) was associated with a lower adjusted risk of in-hospital mortality compared with delayed (≥48 hours) or no PAC use (17.3% vs 27.7%, odds ratio 0.54, 95% confidence interval 0.37–0.81).

(800) Systemic Effects of Impella 5.5 Purge Solution in Patients with Heart Failure Cardiogenic Shock

(800) Systemic Effects of Impella 5.5 Purge Solution in Patients with Heart Failure Cardiogenic Shock

Clinical Outcomes And Changes In Shock Severity Among Patients Hospitalized With Heart Failure Cardiogenic Shock

Clinical Outcomes And Changes In Shock Severity Among Patients Hospitalized With Heart Failure Cardiogenic Shock

Comparison of novel coronavirus pneumonia combined with left heart failure and heavy neocoronary pneumonia in highland snowy areas

This paper collects clinical data from a patient with novel coronavirus pneumonia combined with left heart failure and a patient with severe novel coronavirus pneumonia living in a highland area. We analyzed the difference between the clinical treatment of novel coronavirus pneumonia combined with left heart failure cardiogenic shock and the clinical treatment of severe novel coronavirus pneumonia. The results showed that patients with combined left heart failure presented with typical patchy shadows in both lungs, bilateral pleural effusion, increased BNP, and a minimum partial pressure of oxygen of 48 mmHg at rest, which was converted to negative nucleic acid after antiviral, oxygen therapy, and cardiac diuresis; patients with severe novel coronavirus pneumonia had hemoptysis, multilobar patchy shadows in both lungs, massive ground glass shadows, adjacent pleural adhesions, and no pleural fluid. After oxygen therapy, antiviral drugs and hormone therapy, the patient's SPO2 increased to more than 90%, the pulmonary ground glass shadow was absorbed, and the nucleic acid turned negative. Patients with high altitude severe novel coronavirus pneumonia compared to patients with novel coronavirus pneumonia combined with left heart failure because of more severe hypoxemia due to alveolar exudation, and novel coronavirus pneumonia combined with left heart failure aggravated the severity of the disease. The increased number of hematologic tests, imaging tests, rapid diagnosis and treatment early intervention can reduce mortality in patients with severe novel coronavirus pneumonia.

Abstract 15718: Higher In-Hospital Mortality Among Cardiogenic Shock Patients With De Novo versus Acute on Chronic Heart Failure

Introduction: Heart failure cardiogenic shock (HF-CS) constitutes a heterogenous population and has been identified as the leading type of shock among contemporary intensive care units. The in-hospital trajectory of shock severity and its association with mortality and transition to heart replacement therapy (HRT) or native heart survival (NHS) based on HF-CS phenotype has not been well described. Methods: The Cardiogenic Shock Working Group (CSWG) registry includes patients from 17 hospitals between 2016 and 2021. For this analysis, HF-CS patients were sub-classified as having de novo HF-CS or acute-on-chronic (ACHF) CS. In-hospital trajectories were assessed using baseline and maximum Society for Cardiovascular Angiography and Interventions (SCAI) stages and clinical outcomes were analyzed. Results: A total of 1,767 patients with HF-CS were included. Of these, 349 had de novo HF-CS (19.8%) and 1,371 (77.6%) had ACHF-CS. Overall, patients with de novo HF-CS had greater in-hospital death (32% vs 22%), NHS (58% vs 45%) and less HRT (33% vs 10%) when compared to ACHF-CS (all p&lt;0.001). These variances in clinical outcomes differ when analyzed according to SCAI stages, with more significant differences between de novo HF-CS vs. ACHF-CS across baseline and maximum SCAI Stages C-D (Figure). Conclusions: Using a large contemporary real-world dataset of HF-CS, we identified that de novo HF-CS is associated with higher in-hospital mortality and NHS and lower HRT compared to ACHF-CS. These differences vary depending to SCAI Stage and are more pronounced in SCAI Stages C and D. Further efforts to define shock trajectories and to tailor therapeutics in HF-CS patients are urgently needed.

Should We Be Using Aortic Pulsatility Index Over Cardiac Power Output in Heart Failure Cardiogenic Shock?

HomeCirculation: Heart FailureVol. 15, No. 7Should We Be Using Aortic Pulsatility Index Over Cardiac Power Output in Heart Failure Cardiogenic Shock? No AccessArticle CommentaryRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessArticle CommentaryRequest AccessFull TextShould We Be Using Aortic Pulsatility Index Over Cardiac Power Output in Heart Failure Cardiogenic Shock? Mark N. Belkin, MD, Jay Shah, BS, Maryam E. Neyestanak, PhD, Daniel Burkhoff, MD, PhD and Jonathan Grinstein, MD Mark N. BelkinMark N. Belkin https://orcid.org/0000-0002-9489-4572 Section of Cardiology, University of Chicago Medicine, IL (M.N.B., J.S., M.E.N., J.G.). Search for more papers by this author , Jay ShahJay Shah https://orcid.org/0000-0002-0207-130X Section of Cardiology, University of Chicago Medicine, IL (M.N.B., J.S., M.E.N., J.G.). Search for more papers by this author , Maryam E. NeyestanakMaryam E. Neyestanak https://orcid.org/0000-0002-4895-9849 Section of Cardiology, University of Chicago Medicine, IL (M.N.B., J.S., M.E.N., J.G.). Search for more papers by this author , Daniel BurkhoffDaniel Burkhoff https://orcid.org/0000-0003-3995-2466 Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (D.B.). Search for more papers by this author and Jonathan GrinsteinJonathan Grinstein Correspondence to: Jonathan Grinstein, MD, Section of Cardiology, University of Chicago, 5841 S Maryland Ave, A621, Chicago, IL 60637. Email E-mail Address: [email protected] https://orcid.org/0000-0002-7053-8928 Section of Cardiology, University of Chicago Medicine, IL (M.N.B., J.S., M.E.N., J.G.). Search for more papers by this author Originally published6 Jun 2022https://doi.org/10.1161/CIRCHEARTFAILURE.122.009601Circulation: Heart Failure. 2022;15FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.For Sources of Funding and Disclosures, see page 738.Correspondence to: Jonathan Grinstein, MD, Section of Cardiology, University of Chicago, 5841 S Maryland Ave, A621, Chicago, IL 60637. Email [email protected]bsd.uchicago.edu

Cardiogenic Shock and Temporary Mechanical Circulatory Support.

Cardiogenic shock is a state of circulatory collapse due to low cardiac output resulting from heart failure. Heart failure in this setting may be due to left, right, or biventricular dysfunction. Acute myocardial infarctions remain the most common cause of cardiogenic shock, although in contemporary patient populations, the increasing prevalence of end-stage heart failure has resulted in a growing population of heart failure cardiogenic shock presentations. Clinicians practicing in the cardiac intensive care unit are challenged with these increasingly complex patients. Such patients often require hemodynamic support to improve end-organ perfusion and reduce mortality. Mechanical devices, collectively known as temporary mechanical circulatory support, provide clinicians with additional tools in our armamentarium to combat the increased mortality associated with cardiogenic shock. In this article, we provide an overview of cardiogenic shock and its phenotypic clinical presentations, in addition to providing a description of temporary mechanical circulatory support devices that are currently utilized in the management of cardiogenic shock.

Implementation of a Cardiogenic Shock Team and Clinical Outcomes (INOVA-SHOCK Registry): Observational and Retrospective Study.

BackgroundThe development and implementation of a Cardiogenic Shock initiative focused on increased disease awareness, early multidisciplinary team activation, rapid initiation of mechanical circulatory support, and hemodynamic-guided management and improvement of outcomes in cardiogenic shock.ObjectiveThe objectives of this study are (1) to collect retrospective clinical outcomes for acute decompensated heart failure cardiogenic shock and acute myocardial infarction cardiogenic shock, and compare current versus historical survival rates and clinical outcomes; (2) to evaluate Inova Heart and Vascular Institute site specific outcomes before and after initiation of the Cardiogenic Shock team on January 1, 2017; (3) to compare outcomes related to early implementation of mechanical circulatory support and hemodynamic-guided management versus historical controls; (4) to assess survival to discharge rate in patients receiving intervention from the designated shock team and (5) create a clinical archive of Cardiogenic Shock patient characteristics for future analysis and the support of translational research studies.MethodsThis is an observational, retrospective, single center study. Retrospective and prospective data will be collected in patients treated at the Inova Heart and Vascular Institute with documented cardiogenic shock as a result of acute decompensated heart failure or acute myocardial infarction. This registry will include data from patients prior to and after the initiation of the multidisciplinary Cardiogenic Shock team on January 1, 2017. Clinical outcomes associated with early multidisciplinary team intervention will be analyzed. In the study group, all patients evaluated for documented cardiogenic shock (acute decompensated heart failure cardiogenic shock, acute myocardial infarction cardiogenic shock) treated at the Inova Heart and Vascular Institute by the Cardiogenic Shock team will be included. An additional historical Inova Heart and Vascular Institute control group will be analyzed as a comparator. Means with standard deviations will be reported for outcomes. For categorical variables, frequencies and percentages will be presented. For continuous variables, the number of subjects, mean, standard deviation, minimum, 25th percentile, median, 75th percentile and maximum will be reported. Reported differences will include standard errors and 95% CI.ResultsPreliminary data analysis for the year 2017 has been completed. Compared to a baseline 2016 survival rate of 47.0%, from 2017 to 2018, CS survival rates were increased to 57.9% (58/110) and 81.3% (81/140), respectively (P=.01 for both). Study data will continue to be collected until December 31, 2018.ConclusionsThe preliminary results of this study demonstrate that the INOVA SHOCK team approach to the treatment of Cardiogenic Shock with early team activation, rapid initiation of mechanical circulatory support, hemodynamic-guided management, and strict protocol adherence is associated with superior clinical outcomes: survival to discharge and overall survival when compared to 2015 and 2016 outcomes prior to Shock team initiation. What may limit the generalization of these results of this study to other populations are site specific; expertise of the team, strict algorithm adherence based on the INOVA SHOCK protocol, and staff commitment to timely team activation. Retrospective clinical outcomes (acute decompensated heart failure cardiogenic shock, acute myocardial infarction cardiogenic shock) demonstrated an increase in current survival rates when compared to pre-Cardiogenic Shock team initiation, rapid team activation and diagnosis and timely utilization of mechanical circulatory support.Trial RegistrationClinicalTrials.gov NCT03378739; https://clinicaltrials.gov/ct2/show/NCT03378739 (Archived by WebCite at http://www.webcitation.org/701vstDGd)

A comparison of in-Hospital complications with ST segment elevation resolution after thrombolytic therapy in acute myocardial infarction

Background and objective:&nbsp;The primary goal of thrombolytic therapy in ST-segment elevation myocardial infarction is to restore the complete coronary reperfusion. The aim of the study was to assess the association of in- Hospital complications with ST-segment resolution after thrombolytic therapy in acute myocardial infarction. Methods: &nbsp;The ECG s of 100 patients with first ST-segment elevation myocardial infarction were recorded on admission, 90 and 180 minutes after Alteplase at Hawler Teaching Hospital (Coronary Care Unit) from January 2011 to October 2011. The mean age (±SD)was 59.8±8.4years,ranging from 37-80 years, 63% were males and 37% were females, male to female ratio equal 1.7:1. Patients were divided into three groups: Group (A): complete resolution of ST segment, group (B) : partial resolution and group (C) no resolution of ST-segment, those patients were followed for the detection of in-Hospital complications. Results: Heart failure cardiogenic shock,left ventricular systolic dysfunction and ischemic mitral regurgitation were higher in group (B) and (C) than (A) when ECGs were recorded at 90 and 180 minutes after thrombolysis (P &lt; 0.001). Conclusion: Failure or partial resolution of ST segment can predict the early development of heart failure, shock, left ventricular systolic dysfunction and ischemic mitral regurgitation.