Impact of symptom duration and mechanical circulatory support on prognosis in cardiogenic shock complicating acute myocardial infarction.

Autor: Klein F; Heart Centre, Department of Interventional Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands. florien.klein@catharinaziekenhuis.nl., Crooijmans C; Heart Centre, Department of Interventional Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands., Peters EJ; Heart Centre, Department of Cardiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands., van 't Veer M; Heart Centre, Department of Interventional Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands., Timmermans MJC; Netherlands Heart Registration, Utrecht, The Netherlands., Henriques JPS; Heart Centre, Department of Cardiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands., Verouden NJW; Heart Centre, Department of Cardiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands., Kraaijeveld AO; Department of Cardiology, Utrecht University Medical Centre, Utrecht, The Netherlands., Bunge JJH; Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.; Department of Intensive Care, Erasmus University Medical Centre, Rotterdam, The Netherlands., Lipsic E; Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands., Sjauw KD; Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands., van Geuns RM; Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands., Dedic A; Department of Cardiology, Noordwest Clinics, Alkmaar, The Netherlands., Dubois EA; Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.; Department of Intensive Care, Erasmus University Medical Centre, Rotterdam, The Netherlands., Meuwissen M; Department of Cardiology, Amphia Hospital, Breda, The Netherlands., Danse P; Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands., Bleeker G; Department of Cardiology, Haga Hospital, The Hague, The Netherlands., Montero-Cabezas JM; Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands., Ferreira IA; Department of Cardiology, Isala Hospital, Zwolle, The Netherlands., Brouwer J; Department of Cardiology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands., Teeuwen K; Heart Centre, Department of Interventional Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands., Otterspoor LC; Heart Centre, Department of Interventional Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
Jazyk: angličtina
Zdroj: Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation [Neth Heart J] 2024 Aug; Vol. 32 (7-8), pp. 290-297. Date of Electronic Publication: 2024 Jul 02.
DOI: 10.1007/s12471-024-01881-9
Abstrakt: Background: Mortality rates in patients with cardiogenic shock complicating acute myocardial infarction (AMICS) remain high despite advancements in AMI care. Our study aimed to investigate the impact of prehospital symptom duration on the prognosis of AMICS patients and those receiving mechanical circulatory support (MCS).
Methods and Results: We conducted a retrospective cohort study with data registered in the Netherlands Heart Registration. A total of 1,363 patients with AMICS who underwent percutaneous coronary intervention between 2017 and 2021 were included. Patients presenting after out-of-hospital cardiac arrest were excluded. Most patients were male (68%), with a median age of 69 years (IQR 61-77), predominantly presenting with ST-elevation myocardial infarction (86%). The overall 30-day mortality was 32%. Longer prehospital symptom duration was associated with a higher 30-day mortality with the following rates: < 3 h, 26%; 3-6 h, 29%; 6-24 h, 36%; ≥ 24 h, 46%; p < 0.001. In a subpopulation of AMICS patients with MCS (n = 332, 24%), symptom duration of > 24 h was associated with significantly higher mortality compared to symptom duration of < 24 h (59% vs 45%, p = 0.029). Multivariate analysis identified > 24 h symptom duration, age and in-hospital cardiac arrest as predictors of 30-day mortality in MCS patients.
Conclusion: Prolonged prehospital symptom duration was associated with significantly increased 30-day mortality in patients presenting with AMICS. In AMICS patients treated with MCS, a symptom duration of > 24 h was an independent predictor of poor survival. These results emphasise the critical role of early recognition and intervention in the prognosis of AMICS patients.
(© 2024. The Author(s).)
Databáze: MEDLINE
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