Independent Predictor Of Cardiogenic Shock Research Articles

Prevalence of hyperglycemia on admission and its effect on short-term cardiovascular outcomes of non-ST elevation myocardial infarction: A retrospective study from a tertiary care center in South India

Background and Aim: Hyperglycemia has a significant negative impact on the morbidity and mortality of patients presenting with acute myocardial infarction. This retrospective study was conducted to determine the short-term clinical outcomes (inhospital mortality, cardiogenic shock, acute heart failure, stroke, fatal arrhythmia, and length of stay) of patients with non-ST-elevation myocardial infarction (NSTEMI) patients and to compare the outcomes in NSTEMI patients with and without hyperglycemia on admission. We also wanted to identify the clinical profile and assess the mortality rates in patients with NSTEMI. Materials and Methods: This retrospective study was conducted over 7 years (April 1, 2014–July 31, 2021). The data were extracted from the inpatient medical records and it was analyzed. All adult patients requiring admission in a single medical unit with a diagnosis of NSTEMI were included in the study. Descriptive statistics were obtained for all variables and entered in MS Excel and analyzed with SPSS (SPSS for Windows, version 16.0, Chicago, IL, USA) in the study, and appropriate statistical tests like P value were employed to ascertain the significance. Factors that were significant in univariate analysis were tested by multivariate regression analysis to identify those that independently predicted poor outcomes. Results: Our study cohort consisted of 260 patients, 144 (55.4%) patients had hyperglycemia on admission (admission blood sugar >200 mg/dl), and 116 (44.6%) had normoglycemia. In our cohort, 166 (63.8%) were male. The most common comorbidity was diabetes mellitus 195 (75%) and 134 (68.7%) diabetic patients had hyperglycemia at presentation. The most common clinical outcome was acute heart failure in 225 (86.5%), followed by cardiogenic shock in 110 (42.3%) patients. Fifteen (5.8%) patients had acute cerebrovascular accident during the hospital stay and 39 (15%) had developed fatal arrhythmias. The mean ± standard deviation duration of hospital stay was of 7.09 ± 5.396 days. The mortality in this cohort was 67 (25.8%). The presence of hyperglycemia on admission was not found to have an effect on mortality (odds ratio [OR]: 0.61, 95% confidence interval [CI]: 0.34–1.10, P = 0.102); however, the presence of hyperglycemia on admission was an independent predictor of cardiogenic shock (OR: 2.18, 95% CI: 1.069–4.483, P = 0.032), acute heart failure (OR: 3.52, 95% CI: 1.44–8.59, P = 0.006), and acute cerebrovascular accident (OR: 13.76, 95% CI: 1.67–112.0, P = 0.015). Conclusions: The presence of hyperglycemia on admission is an independent predictor of short-term outcomes such as cardiogenic shock, acute heart failure, and acute cerebrovascular accident; however, it does not have an effect on inhospital mortality. NSTEMI is associated with significant mortality.

OR75. The role of tricuspid annular plane systolic excursion for STEMI patients in the national PCI center

Abstract Aims Tricuspid annular plane systolic excursion (TAPSE) is one of the most established echocardiographic parameters to assess global function of the right ventricle (RV). This study sought to evaluate TAPSE to predict early outcomes and ascertain whether its value adds beneficial prognostic information to patients with myocardial infarction. Methods and Results Of all 899 patients who were diagnosed with ST-segment elevated myocardial infarction (STEMI) between July 2018 to June 2019, 576 patients underwent echocardiography examination within 24-hour of onset. The subjects were categorized into two groups: TAPSE ≤18 mm (n = 265) and TAPSE >18 mm (n = 311). Primary outcomes were the incidence of cardiogenic shock, cardiac arrest, and in-hospital mortality. A total of 576 patients (513 males, mean age 55±10) with STEMI diagnosis who underwent percutaneous coronary intervention were enrolled to this study. In the overall cohort, TAPSE ≤18 mm was statistically associated with greater incidence of cardiogenic shock (p = 0.001), cardiac arrest (p = 0.002), and in-hospital mortality (p = 0.001). Multivariate analysis showed that TAPSE ≤18 mm was an independent predictor of cardiogenic shock (OR, 2.951; 95% CI, 1.507 to 5.781), cardiac arrest (OR, 2.500; 95% CI, 1.381 to 4.527), and in-hospital mortality (OR, 2.868; 95% CI, 1.460 to 5.632). Conclusion The assessment of TAPSE that represents RV function among STEMI patients can be considered as a prognostic factor regarding early outcomes. Long-term follow-up is necessary to obtain more comprehensive prognostic information.

Comparison of Outcomes in Patients With Takotsubo Syndrome With-vs-Without Cardiogenic Shock

There is limited data on the in-hospital outcomes of cardiogenic shock (CS) secondary to takotsubo syndrome (TS). We aimed to assess the incidence, predictors, and outcomes of CS in hospitalized patients with TS. All patients with TS were identified from the National Inpatient Sample database from September 2006 to December 2017. The cohort was divided into those with versus without CS and logistic regression analysis was used to identify predictors of CS and mortality in patients admitted with TS. A total of 260,144 patients with TS were included in our study, of whom 14,703 (6%) were diagnosed with CS. In-hospital mortality in patients with CS was approximately six-fold higher compared with those without CS (23% vs 4%, p <0.01). TS patients with CS had a higher incidence of malignant arrhythmias like ventricular tachycardia or ventricular fibrillation (15.0% vs 4%, p <0.01) and non-shockable cardiac arrests (12% vs 2%, p <0.01). Independent predictors of CS were male gender, Asian and Hispanic ethnicity, increased burden of co-morbidities including congestive heart failure, chronic pulmonary disease, and chronic diabetes. Independent predictors of mortality were male gender, advanced age, history of congestive heart failure, chronic renal failure, and chronic liver disease. In conclusion, CS occurs in approximately 6% of patients admitted with TS, in-hospital mortality in TS patients with CS was approximately six-fold higher compared with those without CS (23% vs 4%, p <0.01), male gender and increased burden of co-morbidities at baseline were independent predictors of CS and mortality.

Elevation of ST-segment in aVR is predictive of cardiogenic shock but not of multivessel disease in inferior myocardial infarction

IntroductionSome studies suggest that ST elevation in aVR (aVR-STE) can predict the presence of left main or multivessel disease (MVD) and relates to prognosis. Our purpose was to analyze the relationship of aVR-STE to MVD disease or cardiogenic shock (CS) in patients with inferior myocardial infarction (inferior STEMI). MethodsWe analyzed two cohorts of consecutive patients admitted for inferior STEMI in the Coronary Unit of two university hospitals. ST elevation and ST depression in each derivation were compared between patients with and without MVD and with and without CS. ResultsWe included 342 patients—19.6% women and 80.4% men—with a median age of 60 (52, 70); 18 patients (5.2%) had MVD, and 25 (7.3%) patients presented CS. There was no relationship between ST elevation or ST depression in either derivation and MVD. In contrast, CS was associated with aVR-STE, ST-segment depression in lead aVL, and the sum of ST-segment depression. aVR-STE of 0.25 mm had a sensitivity of 24.0% and a specificity of 95.9% for CS. After multivariate analysis including clinical variables, aVR-STE was independently associated with CS. ConclusionsIn patients with inferior STEMI, ST-segment analysis was not useful in predicting multivessel disease. aVR-STE was an independent predictor of CS, with high specificity but low sensitivity.

P1721Determination of a predictive score of cardiogenic shock in acute coronary syndrome

Abstract Introduction Cardiogenic shock is one of the leading causes of death in patients with acute coronary syndrome (ACS), reaching in-hospital mortality rates of 50%. Purpose To identify a predictive score of cardiogenic shock in patients with ACS. Methods We performed a retrospective, descriptive and correlational study encompassing patients admitted with ACS in a Cardiology service from 1st October 2010 to 1st October 2018. Demographic factors, risk factors, antecedents and clinical characteristics were analyzed. The correlation between the categorical variables was performed by the Chi-square test, while the T-Student test was applied to the continuous variables, with a significance level of 95%. Independent predictors of cardiogenic shock were identified through a binary logistic regression analysis, considering p=0,05. Then, a discriminatory function was applied using the Wilks lambda test to determine the discriminant score of the analized groups. Statistical analysis was conducted with SPSS 24.0. Results During this period, 4458 patients were admitted with ACS and 74 (1,7%) developed cardiogenic shock. In this subgroup, 59,5% were over 65 years of age, 63,5% were male and 93,2% presented with acute myocardial infarction with ST segment elevation. Also, 83,8% were in sinus rhythm at admission, 22,7% had creatinine&gt;1,5 mg/dL and 17,9% had left ventricular ejection fraction (LVEF) &lt;30%. The in-hospital mortality rate was 51,4%. LVEF &lt;30% (p=0,018), creatinine&gt;1,5 mg/dL (p=0,044) and absence of sinus rhythm at admission (p=0,041) were independent predictors of cardiogenic shock. A predictive score of this complication in patients with ACS was determined using the formula: 1,723 + 1,505 x (creatinine&gt;1,5) + 4,483 x (LVEF &lt;30%) – 2,094 x (sinus rhythm at admission). A cutoff of 0,58 was obtained with 44,4% sensitivity, 85,2% specificity and 85% discriminative power. Conclusion Cardiogenic shock occurred in 1,7% of patients admitted with ACS and was associated with a high mortality rate. We determined a predictive score of this complication with a good discriminative power, which included LVEF &lt;30%, creatinine &gt;1,5 mg/dL and the rhythm on admission's electrocardiogram. By taking into account clinical variables, this score can be used at a very early stage of admission, allowing risk stratification of developing cardiogenic shock in each patient. However, it needs validation to be applied in clinical practice.

The association of right ventricular dysfunction with in-hospital and 1-year outcomes in anterior myocardial infarction

In anterior ST-segment elevation myocardial infarction (STEMI), attention paid mainly to the left ventricle. The predictive significance of right ventricular (RV) dysfunction in patients with anterior STEMI has been frequently neglected. In this study, we evaluated the prognostic effect of RV dysfunction on in-hospital and long-term outcomes in patients with first anterior STEMI. A total of 350 patients without known coronary artery disease with first anterior STEMI and treated with primary percutaneous coronary intervention were prospectively enrolled in this study. In-hospital and long-term outcomes were compared between two groups of with or without RV dysfunction. In-hospital mortality was significantly higher in the RV dysfunction group (26.7% vs. 1.6%, P < 0.001). The RV dysfunction group also had a higher incidence of cardiogenic shock, recurrent myocardial infarction, target lesion revascularization and stent thrombosis. The 1-year overall survival in patients with and without RV dysfunction was 62.2% and 95.0% respectively. After multivariable analysis, RV dysfunction remained as an independent predictor for in-hospital and long-term mortality. RV dysfunction is an independent predictor of cardiogenic shock, recurrent myocardial infarction, and, in-hospital and long-term mortality in anterior STEMI. Therefore, attention should be paid to the function of right ventricle as in the left ventricle after anterior STEMI.

0286 : Predictive factors of cardiogenic shock in acute phase of acute coronary syndrome: prospective study

Cardiogenic shock is usually considered a sequel of ST-segment elevation myocardial infarction. This study assessed the incidence and Predictive factors of cardiogenic shock developing after enrollment among patients with and without ST-segment elevation. Among 198 patients who did not present with cardiogenic shock, 80 (40%) had and 100 (50%) did not have ST-segment elevation on the enrollment ECG. Cardiogenic shock developed in 7.2% Of ST-segment elevation patients compared with 5.5% of patients without ST-segment. Shock developed significantly later among patients without ST-segment elevation. The main cause of cardiogenic shock was primitive in connection with impaired LV systolic function, followed by a severe ventricular arrhythmia. Vasopressor therapy was prescribed in 85.7% of patients. A systolic electro drive probe was placed in 28%. An external shock was performed in 28%. The hospital mortality was 40%. Independent predictors of cardiogenic shock occurred are the extended territory VD (p < 0.004) ; the biventricular dysfunction (p < 0.002), severe ischemic mitral regurgitation (p < 0.003), high blood glucose (p <0.005), elevated troponins (p < 0.004), and TIMI flow < 2 (p < 0, 0001). Cardiogenic shock occurs in the setting of acute ischemic syndromes remains a therapeutic challenge. Patient characteristics, timing, clinical course, echocardiographic and angiographic findings differ between the 2 groups. The author hereby declares no conflict of interest

Deadly association of cardiogenic shock and chronic total occlusion in acute ST-elevation myocardial infarction

The association between cardiogenic shock and 1 or >1 chronic total occlusion (CTO) in unselected patients presenting with ST-elevation myocardial infarction (MI) (STEMI) has not been characterized. Patients with STEMI referred with or without cardiogenic shock were categorized into no CTO, 1 CTO, and >1 CTO. The primary end point was the 30-day mortality. Between 2006 and 2011, 2,020 consecutive patients were included. A total of 141 patients (7%) presented with cardiogenic shock on admission. The prevalence of 1 CTO and >1 CTO in a non-infarct-related artery was 23% and 5%, respectively, among patients with shock compared with 6% and 0.5% in patients without shock (P < .0001). Independent predictors of cardiogenic shock included left main-related MI (odds ratio [OR] 6.55, 95% CI 1.39-26.82, P = .019), CTO (OR 4.20, 95% CI 2.64-6.57, P < .001), creatinine clearance <60 mL/min (OR 3.41, 95% CI 2.32-4.99, P < .0001), and left anterior descending-related MI (OR 2.20, 95% CI 1.51-3.23, P < .0001). Thirty-day mortality was 100% in shock patients with >1 CTO, 65.6% with 1 CTO, and 40.2% in patients without CTO (P < .0001). After adjustment for left ventricular ejection fraction and renal function, CTO remained an independent predictor for 30-day mortality (hazard ratio [HR] 1.83; 95% CI 1.10-3.01, P = .02). In patients with STEMI, CTO was strongly associated with cardiogenic shock on admission. In this setting, mortality was substantially higher in patients with 1 CTO and exceedingly high in those with >1 CTO. The presence of CTO was an independent predictor of early mortality.

Distortion of the terminal portion of the QRS is predictor of shock after primary percutaneous coronary intervention for acute myocardial infarction

Background Although invasive management of ST segment elevation myocardial infarction has improved the clinical outcome, cardiogenic shock (CS) remains an important issue. Our purpose was to asses the utility of the initial electrocardiogram in detecting patients who are at increased risk of CS after percutaneous coronary intervention for acute myocardial infarction. Methods We evaluated 508 consecutive patients admitted in our Coronary Unit and treated by primary angioplasty within 12 h of an ST segment elevation myocardial infarction. Patients with cardiogenic shock at admission were excluded. Two groups were defined according to the presence of distortion of the terminal portion of the QRS in two or more adjacent leads (group 1) or the absence of this pattern (group 2). Results There were 99 patients (20%) in group 1 and 409 (80%) in group 2. CS developed in 38 patients, 18 in group 1 (18%) and 20 in group 2 (5%), p < 0.001. Seventeen patients died in hospital, 6 in group 1 (6%) and 11 in group 2 (3%), p 0.094. Multivariate analysis including clinical, electrocardiographic and angiographic variables showed distortion of the QRS as an independent predictor of cardiogenic shock (odds ratio 3.17, 95% confidence interval 1.44 to 6.96, p 0.004), together with Killip class at admission and TIMI 3 flow after revascularization. Conclusions Distortion of the terminal portion of the QRS complex is a strong predictor of cardiogenic shock in STEMI patients. Close hemodynamic monitoring should be warranted in patients showing this electrocardiographic pattern.