Predictive Factors and Outcomes in Cardiogenic Shock in the Setting of Acute Myocardial Infarction

Introduction: Acute myocardial infarction (AMI) is the one of the leading causes of death in the United States and worldwide. In recent years, there has been a decline in the incidence and case fatality of AMI, which is partly attributed to the advancements in management including timely reperfusion and medical therapies. Cardiogenic shock (CS) is a life-threatening complication in patients with acute coronary syndrome (ACS), and its development can be unpredictable. The aim of this study was to find independent predictive factors of CS in cohort of ACS patients.

Methods: This was a retrospective, comparative, and analytical monocentric study, including 319 ACS patients admitted at Department of Surgery, 250 Bed District Sadar Hospital, Habiganj, Bangladesh from January to December 2024. Patients who presented with CS on admission were excluded from the study. This population was divided into two groups: the shock group patients eventually developed in-hospital CS and the no shock group which did not, and we compared overall patient characteristics and outcomes. Studied characteristics included patient demographics (age, sex), medical history (cardiovascular risk factors and comorbidities), clinical status including the presence of heart failure (HF), electrocardiogram data, laboratory findings such as high-sensitivity troponin and glomerular filtration rate (eGFR), echocardiographic findings mainly left ventricular ejection fraction (LVEF) and left ventricular hypertrophy (LVH), and lesions found during coronary angiography.

Results: 319 ACS patients were included, among them 21 (6,6%) developed CS. Overall, the strongest predictive factors included the presence of acute heart failure on admission (OR = 14,83; 95% CI = 5,45 – 40,32; p < 0,001), GRACE score ≥ 140 (OR = 9,03; 95% CI = 3,20 – 25,46; p < 0,001), left ventricular ejection fraction < 50% (OR = 8,94; 95% CI = 3,08 – 19,53; p < 0,001), eccentric left ventricular hypertrophy (OR = 9,78; 95% CI = 2,61 – 36,70; p < 0,001), and right ventricular dysfunction (OR = 12,25; 95% CI = 2,55 – 58,93; p = 0,002). Complications were more prevalent in the shock group with a higher mortality rate of 57,1%.

Conclusion: CS in the setting of ACS is correlated with poorer prognosis and higher late mortality, justifying adequate and early diagnosis and management in high-risk patients.

Keywords: Cardiogenic Shock, Acute Coronary Syndrome, Predictive Factors.