• Shock · Jan 2025

    Comparative Study

    DIFFERENCES ON IN-HOSPITAL OUTCOMES IN PATIENTS WITH CARDIOGENIC SHOCK DUE TO STEMI VERSUS NSTEMI USING A NATIONWIDE DATABASE.

    • Carlos Diaz-Arocutipa, Héctor Bueno, Guillermo Moreno, Víctor Juárez Olmos, and Lourdes Vicent.
    • Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru.
    • Shock. 2025 Jan 1; 63 (1): 364236-42.

    AbstractBackground: Our study aims to compare in-hospital management and outcomes in patients with cardiogenic shock due to ST-segment elevation myocardial infarction (STEMI) versus non-ST-segment elevation myocardial infarction (NSTEMI). Methods: We conducted a retrospective cohort study using the National Inpatient Sample database between 2016-2019, including patients with STEMI/NSTEMI complicated by cardiogenic shock. An inverse probability treatment weighting analysis was performed to compare in-hospital management and outcomes between patients with STEMI and NSTEMI. Adjusted relative risks (aRR) with their 95% confidence intervals (CIs) were estimated. Results: A total of 150,395 patients with cardiogenic shock due to acute myocardial infarction were included, of whom 52.8% had STEMI. The median age was 68 years (60-77) and 35% were female. Percutaneous coronary intervention, intra-aortic balloon counterpulsation, percutaneous ventricular assist device, extracorporeal membrane oxygenation, and mechanical ventilation use were significantly higher in the STEMI group compared to NSTEMI. Coronary artery bypass grafting, renal replacement therapy, length of hospital stay, and total costs were lower in the STEMI group. Pulmonary arterial catheterization and cardiac transplantation were similar between both groups. Inverse probability treatment weighting analysis showed that in-hospital mortality was significantly higher in the STEMI group compared to NSTEMI (34.2% vs. 28.8%, aRR 1.19, 95% CI 1.14-1.23) and also major bleeding. Conclusion: In conclusion, patients with cardiogenic shock due to STEMI had worse prognosis, higher use of percutaneous coronary intervention/mechanical circulatory support, and major bleeding than the NSTEMI group. In contrast, patients with NSTEMI had greater use of coronary artery bypass grafting and hospital resources.Copyright © 2024 by the Shock Society.

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