Clinical outcomes of patients with cardiogenic shock complicating acute myocardial infarction: The Gulf-Cardiogenic Shock (G-CS) Registry.

ABSTRACT

BACKGROUND: There is a paucity of data regarding acute myocardial infarction (MI) complicated by cardiogenic shock (AMI-CS) in the Gulf region. This study addressed this knowledge gap by examining patients experiencing AMI-CS in the Gulf region and analyzing hospital and short-term follow-up mortality. METHODS: The Gulf-CS registry included 1,513 patients with AMI-CS diagnosed between January 2020 and December 2022. RESULTS: The incidence of AMI-CS was 4.1% (1513/37379). The median age was 60 years. The most common presentation was ST-elevation MI (73.83%). In-hospital mortality was 45.5%. Majority of patients were in SCAI stage D and E (68.94%). Factors associated with hospital mortality were previous coronary artery bypass graft (OR2.49; 95%CI 1.321-4.693), cerebrovascular accident (OR1.621, 95%CI 1.032-2.547), chronic kidney disease (OR1.572; 95%CI1.158-2.136), non-ST-elevation MI (OR1.744; 95%CI 1.058-2.873), cardiac arrest (OR5.702; 95%CI 3.640-8.933), SCAI stage D and E (OR19.146; 95CI% 9.902-37.017), prolonged QRS (OR10.012; 95%CI 1.006-1.019), right ventricular dysfunction (OR1.679; 95%CI 1.267-2.226) and ventricular septal rupture (OR6.008; 95%CI 2.256-15.998). Forty percent had invasive hemodynamic monitoring, 90.02% underwent revascularization, and 45.80% received mechanical circulatory support (41.31% had Intra-Aortic Balloon Pump and 14.21% had Extracorporeal Membrane Oxygenation/Impella devices). Survival at 12 months was 51.49% (95% CI 46.44- 56.29%). CONCLUSIONS: The study highlighted the significant burden of AMI-CS in this region, with high in-hospital mortality. The study identified several key risk factors associated with increased hospital mortality. Despite the utilization of invasive hemodynamic monitoring, revascularization, and mechanical circulatory support in a substantial proportion of patients, the 12-month survival rate remained relatively low.