The Trend of Intra-Hospital Mortality Rate in ST-Segment Elevation Myocardial Infarction-Cardiogenic Shock (STEMI-CS) Over One Decade, and Association with New Therapeutic Approaches

This study aimed to assess the trends in management and in-hospital mortality of patients admitted with cardiogenic shock complicating ST-segment elevation myocardial infarction (STEMI-CS) between 2009 and 2018, and its association with new therapeutic modalities.

In this retrospective study, all patients with STEMI-CS from 2009 to 2018 in Shahid Madani Heart Center in northwest of Iran were enrolled (n = 410). Patients were classified into two five-year periods based on the year of admission, 162 patients in the first period (2009-2013) and 248 patients in the second period (2014-2018) were included in this study. Demographic data, risk factors, clinical symptoms, treatment strategies, and in-hospital mortality were compared between the two periods.

Therapeutic approaches including thrombolysis, percutaneous coronary intervention (PTI), coronary artery bypass grafting (CABG), and intra-aortic balloon pump were similar between two periods, and the only significant difference in treatment was the higher rate of using glycoprotein IIb/IIIa inhibitor in the second period (20.2% vs. 43.9%, respectively; P = 0.001). However, higher in-hospital mortality rate was found in 2009-2013 period compared to 2014-2018 period (80.8% vs. 69.7%, respectively; P = 0.010). Multivariate regression analysis showed that only coronary revascularization, either percutaneous or CABG, were independently associated with a lower mortality risk (Odds ratio of 0.26 and 0.21, respectively; P < 0.001 for both).

The results of this study showed that the therapeutic approaches in patients with STEMI-CS did not improve significantly over one decade, and most patients did not undergo coronary revascularization.