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Management and predictors of outcome in unselected patients with cardiogenic shock complicating acute ST-segment elevation myocardial infarction: results from the Bremen STEMI Registry

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Abstract

Introduction

Patients with ST-segment elevation myocardial infarction (STEMI) and consecutive cardiogenic shock (CS) represent a challenge in clinical practice. Only few ‘real-world’ data on therapeutic management and outcome exist.

Methods

The present analysis focuses on changes of clinical management of STEMI-patients with CS and analyzes predictors of outcome using the Bremen-STEMI registry.

Results

Out of 7865 patients with STEMI, 981 patients (13%) presented with CS. Most CS patients (88%) underwent an early percutaneous intervention (PCI). Intraaortic balloon pumps (IABP) were less implanted since 2013 (p < 0.001), the rate of drug-eluting stents and periprocedural prasugrel or ticagrelor therapy increased over the years. Overall in-hospital mortality of patients with CS was 37%, 1 year mortality was 50%. A significantly reduced 1-year mortality (2006–2009: 55%, 2010–2013: 50%; 2014–2015: 43%, p = 0.027) was observed. In a multivariate analysis significant predictors of an increased 1-year mortality were acute renal failure (OR 3.6; 95% CI 1.9–7.0), atrial fibrillation (OR 2.8; 95% CI 1.3–6.0), three-vessel disease (OR 2.5; 95% CI 1.3–4.7), age ≥ 75 years (OR 2.4, 95% CI 1.3–4.4) and anemia (OR 1.9; 95% CI 1.1–3.3). A successful performed PCI (OR 0.5, 95% CI 0.2–0.9) was associated with a significantly reduced 1-year mortality.

Conclusion

management of patients with CS changed with a steep decrease of IABP implantations. Mortality of patients with CS decreased over the last 10 years. Especially, performance of successful PCI was associated with a reduction of mortality, indicating the crucial role of early revascularization to improve prognosis in this high-risk cohort of STEMI-patients.

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Authors and Affiliations

  1. Bremer Institut für Herz- und Kreislaufforschung, Klinikum Links der Weser, Klinik für Kardiologie und Angiologie, Senator-Weßling-Str. 1, 28277, Bremen, Germany

    Tina Backhaus, Andreas Fach, Johannes Schmucker, Eduard Fiehn, Daniela Garstka, Janina Stehmeier, Rainer Hambrecht & Harm Wienbergen

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  1. Tina Backhaus
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  2. Andreas Fach
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Correspondence to Tina Backhaus.

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Backhaus, T., Fach, A., Schmucker, J. et al. Management and predictors of outcome in unselected patients with cardiogenic shock complicating acute ST-segment elevation myocardial infarction: results from the Bremen STEMI Registry. Clin Res Cardiol 107, 371–379 (2018). https://doi.org/10.1007/s00392-017-1192-0

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  • DOI: https://doi.org/10.1007/s00392-017-1192-0

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