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. 2025 May 27;5(1):200.
doi: 10.1038/s43856-025-00874-y.

Risk factors for cardiogenic shock incidence and mortality after acute myocardial infarction: a systematic review and meta-analysis

Mailikezhati Maimaitiming  1   2 , Siwen Li  1   2 , Kepei Huang  1   2 , Mulatijiang Maimaitiming  3 , Feng Liu  4 , Sidney C Smith  5 , Zhi-Jie Zheng  1   2 , Yinzi Jin  6   7
Affiliations

Risk factors for cardiogenic shock incidence and mortality after acute myocardial infarction: a systematic review and meta-analysis

Mailikezhati Maimaitiming et al. Commun Med (Lond). .

Abstract

Background: Cardiogenic shock (CS) is a serious complication of acute myocardial infarction (AMI), which could lead to severe health loss. This systematic review aimed to analyze the risk factors related to the incidence and poor outcomes of cardiogenic shock after acute myocardial infarction (AMI-CS), including in-hospital death, 30-day death and 1-year death.

Methods: Original studies were systematically searched in PubMed and Embase up to November 2022. The summary odds ratio (OR) and 95% confidence interval (CI) of all studies were acquired based on a random effect model or fixed effect model. Subgroup analyses were conducted according to the study design, followed by sensitive analyses. The protocol was registered on PROSPERO (registration number: CRD42023466123).

Results: There are 25 studies enrolled, including 12 cross-sectional studies, ten retrospective cohort studies, and three case-control studies. The pooled results reveal that female sex (OR, 1.10; 95% CI, 1.09-1.11), advanced age (OR, 1.06; 95% CI, 1.03-1.09), smoking (OR, 1.36; 95% CI, 1.26-1.45), diabetes (OR, 1.45; 95% CI, 1.08-1.82), and ST-segment elevation myocardial infarction (STEMI; OR, 1.99; 95% CI, 1.34-2.63) are significantly associated with the development of AMI-CS. Among these factors, all except smoking increase the risk of in-hospital death among AMI-CS patients. Advanced age (OR, 1.08; 95% CI, 1.04-1.12) and diabetes (OR, 1.77; 95% CI, 1.25-2.29) have negative impacts on 30-day death, while advanced age (OR, 2.10; 95% CI, 1.70-2.50) and STEMI (OR, 1.55; 95% CI, 1.15-1.95) are associated with 1-year death.

Conclusions: Our findings highlight the significance of risk factors in predicting the incidence and prognosis of AMI-CS. Early identification and targeted interventions for individuals with these risk factors could potentially help prevent the occurrence of AMI-CS and improve patient outcomes.

Plain language summary

Heart failure after a heart attack poses considerable threats to the health of patients with high incidence rate and increased death. However, identification of the key risk factors involved in heart failure after a heart attack remains unknown. This systematic review article compiles findings from current research on heart failure following a heart attack to examine patterns between groups and determine potential risk factors. We find that risk factors include female sex, advanced age, smoking, diabetes, and a severe heart attack with complete blockage. All these factors, except smoking, increase the risk of in-hospital death. These findings highlight the need for preventative care for individuals with these risk factors to prevent mortality.

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Conflict of interest statement

Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Flowchart for study selection.
The diagram illustrates the procedure followed to identify the eligible studies. Studies were excluded in each critical screening step based on the eligibility criteria.
Fig. 2
Fig. 2. Forest plot of sensitive analysis for the association between female, advanced age, and STEMI and AMI-CS development.
a Sensitive analysis for the association between female and AMI-CS development. b Sensitive analysis for the association between advanced age and AMI-CS development. c Sensitive analysis for the association between STEMI and AMI-CS development. The random- effects model was used to estimate the pooled effect of female, advanced age and STEMI on reducing the risk of AMI-CS development. The green diamond shape and the red dotted line show the effect size (odds ratio with 95% confidence interval) in each group, while the lateral tips of the diamond represent the confidence interval. The square shapes in individual study suggests the effect size estimate, while the bigger the shape, the larger the sample size and the reverse is true. AMI-CS cardiogenic shock after acute myocardial infarction, CI confidence interval, OR odds ratio, STEMI ST-segment elevation myocardial infarction.
Fig. 3
Fig. 3. Forest plot of sensitive analysis for the association between female and advanced age and in-hospital death among AMI-CS patients.
a Sensitive analysis for the association between female and in-hospital death. b Sensitive analysis for the association between advanced age and in-hospital death. The random- effects model was used to estimate the pooled effect of female and advanced age on reducing the risk of AMI-CS in-hospital death. The green diamond shape and the red dotted line show the effect size (odds ratio with 95% confidence interval) in each group, while the lateral tips of the diamond represent the confidence interval. The square shapes in individual study suggests the effect size estimate, while the bigger the shape, the larger the sample size and the reverse is true. AMI-CS cardiogenic shock after acute myocardial infarction, CI confidence interval, OR odds ratio.
Fig. 4
Fig. 4. Forest plot of sensitive analysis for the association between advanced age and diabetes and 30-day death among AMI-CS patients.
a Sensitive analysis for the association between advanced age and diabetes and 30-day death; b Sensitive analysis for the association between diabetes and diabetes and 30-day death. The random- effects model was used to estimate the pooled effect of advanced age and diabetes on reducing the risk of AMI-CS 30-day death. The green diamond shape and the red dotted line show the effect size (odds ratio with 95% confidence interval) in each group, while the lateral tips of the diamond represent the confidence interval. The square shapes in individual study suggests the effect size estimate, while the bigger the shape, the larger the sample size and the reverse is true. AMI-CS cardiogenic shock after acute myocardial infarction, CI confidence interval, OR odds ratio.
Fig. 5
Fig. 5. Forest plot of sensitive analysis for the association between advanced age and 1-year death among AMI-CS patients.
The random- effects model was used to estimate the pooled effect of advanced age on reducing the risk of AMI-CS 1-year death. The green diamond shape and the red dotted line show the effect size (odds ratio with 95% confidence interval) in each group, while the lateral tips of the diamond represent the confidence interval. The square shapes in individual study suggests the effect size estimate, while the bigger the shape, the larger the sample size and the reverse is true. AMI-CS cardiogenic shock after acute myocardial infarction, CI confidence interval, OR odds ratio.
See this image and copyright information in PMC

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