Comparative analysis of cardiogenic shock outcomes in acute myocardial infarction with polyvascular disease

Abstract

Background: Cardiogenic shock (CS) is the leading cause of mortality in acute myocardial infarction (AMI) patients, especially in those with vascular disease. This study aimed to assess the association between extent of polyvascular disease and the in hospital management and outcome of patients with AMI-induced CS.

Method: Using the National Inpatient Sample from 2016 to 2019, adult patients with AMI and CS with known vascular disease were identified and stratified by number of diseased vascular beds and into STEMI and NSTEMI subgroups. The study assessed in-hospital major adverse cardiovascular and cerebrovascular events (MACCE), mortality, acute CVA and major bleeding, as well as invasive management by number of diseased vascular beds.

Results: Out of 136,245 patients, 57.9 % attributed to STEMI and 42.1 % to NSTEMI. The study revealed that the likelihood of percutaneous coronary intervention (PCI) [(aOR for 2 beds 0.94, CI 0.91-0.96, p-value < 0.001; 3 beds 1.0, CI 0.94-1.06, p-value 0.96)] and coronary artery bypass grafting (CABG) [(aOR for 2 beds 0.66, CI 0.64-0.69, p-value < 0.001; 3 beds 0.76, CI 0.71-0.81, p-value < 0.001)] decreased as the number of diseased vascular sites increased. The study also highlighted a direct dose-response relationship between the number of diseased vascular beds and major adverse outcomes, including MACCE, mortality and acute CVA, underscoring the prognostic significance of polyvascular disease in this patient population.

Conclusion: The study demonstrated that polyvascular disease significantly worsens AMI-induced CS outcomes. The findings highlight the importance of early identification and aggressive management of polyvascular disease in these patients. Further research is needed to develop targeted treatment strategies for this high-risk population.

Keywords: Acute myocardial infarction; Cardiogenic shock; Outcomes; Poly-vascular disease.

Graphical abstract

Fig. 1

Flow diagram.

Fig. 2

Dose-response relationship between number of affected vascular beds and clinical procedures and outcomes.

Fig. 3

Adjusted OR for in-hospital procedures and complications based on the number of disease vascular beds.

Fig. 4

Adjusted OR for in-hospital procedures and complications for cardiogenic shock secondary to STEMI based on the number of disease vascular beds.

Fig. 5

Adjusted OR for in-hospital procedures and complications for cardiogenic shock secondary to NSTEMI based on the number of disease vascular beds.