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Predictors of in-hospital mortality in myocardial infarction presenting with cardiogenic shock
Session:
Comunicações Orais - Sessão 04 - Choque cardiogénico
Speaker:
Nazar Ilchyshyn
Congress:
CPC 2023
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
14. Acute Cardiac Care
Subtheme:
14.4 Acute Cardiac Care – Cardiogenic Shock
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Nazar Ilchyshyn; Ana Catarina Gomes; Ana Isabel Marques; Alexandra Briosa; João Grade Santos; Bárbara Ferreira; Mariana Martinho; Diogo Cunha; Oliveira Baltazar; João Luz; Ana Rita Pereira; Gonçalo Morgado; Rita Calé; Cristina Martins; Hélder Pereira; On Behalf of The Portuguese Registry of Acute Coronary Syndrome Investigators
Abstract
<p><strong>Introduction:</strong> Myocardial infarction (MI) presenting with cardiogenic shock (CS) carries a high potential for hazard outcome. Despite therapeutic advances, CS mortality rate remains high.</p> <p><br /> <strong>Purpose:</strong> Our aim was to characterize the population presenting with MI and CS and assess in-hospital, 1- and 6- month mortality rates, mortality trends and predictors of in-hospital mortality.</p> <p><br /> <strong>Methods:</strong> Retrospective analysis of all patients admitted with MI and CS between 2010 and 2022 included in the ProACS. Medical records were analyzed for demographic, procedural data and mortality outcomes. Mortality trends over the past 12 years were assessed using chi-square test for linear trend. Logistical forward stepwise regression was performed to assess in-hospital mortality predictors.</p> <p><br /> <strong>Results:</strong> 660 patients presented with MI and CS. The mean age was 69.2 ± 13.2 years-old, 68% male, 17% obese, 23.7% smokers, 69.8% hypertensive, 39% diabetic and 55.6% had dyslipidemia. 16.4% had previous history of MI and 19.3% had chronic coronary syndrome. 11.9% had history of chronic kidney disease (CKD) and 10.8% of heart failure. Time from symptom onset to first medical contact was >120 min in 52.1%. 82.9% had STEMI, 49.5% being anterior MI and 46.5% inferior MI. 90.3% of reperfusion group was submitted to PCI. 60.9% had multivessel disease. Culprit lesion was left main coronary artery (LMCA) in 9.2%, left anterior descending artery (LAD) in 33.4%, circumflex artery in 10.3%, right coronary artery (RCA) in 35.1% and other in 11.9%. 23.7% needed invasive mechanical ventilation (IMV), 7.6% needed circulatory assist device and 11.1% needed temporary pacemaker.<br /> In-hospital, 1- and 6-month mortality was 36,4%, 37.3% and 38.9%, respectively, with a statistically significant trend for decrease in mortality in all 3 groups (p= 0.038, p=0.043 and p=0.042).<br /> In-hospital mortality was associated with ≥75 years-old (OR 2.36, p=0.001), obesity (OR 1.67, p=0.025), time from symptom onset to first medical contact >120 min (OR 1.53, p=0.04), hypertension (OR 1.17, p=0.001), diabetes (OR 1.43, p=0.001), dyslipidemia (OR 1.23, p=0.001), CKD (OR 1.55, p=0.001), STEMI (OR 2.40, p=0.001), Creatinine >2.0 mg/dL (OR 1.88, p=0.001), Hemoglobin <8g/dL (OR 1.53, p=0.001), LMCA-disease (OR 3.25, p=0.001), pre-hospital fibrinolysis (OR 9.86, p=0.001), need for intra-aortic balloon (OR 2.10, p=0.013), IMV (OR 1.54, p=0.02), while PCI was protective (OR 0.41, p=0.001).<br /> Logistic regression model revealed ≥75 years-old, time from symptom onset to first medical contact >120 min, LMCA as culprit lesion and use of IMV as predictors of in-hospital mortality.</p> <p><strong>Conclusions:</strong> Predictors of in-hospital mortality were old age, delay in seeking medical assistance, LMCA as culprit lesion and the need for IMV. There was a decrease in CS mortality over the years, probably due to improvement of therapeutic management (including PCI-procedures).</p>
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