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. 2025 Aug;20(5):1481-1491.
doi: 10.1007/s11739-025-03984-6. Epub 2025 Jun 13.

The impact of cardiogenic shock and out-of-hospital cardiac arrest on the outcome of acute myocardial infarction: a national-level analysis

Pavol Tomasov  1   2 , Zuzana Motovska  3 , Ota Hlinomaz  4 , Petr Kala  5 , Marek Sramko  6 , Jan Mrozek  7 , Milan Hromadka  8 , Jan Precek  9 , Josef Bis  10 , Jan Matejka  11 , Tamilla Muzafarova  2 , Pavel Cervinka  12 , Ales Kovarik  13 , Libor Sknouril  14 , Zdenek Coufal  15 , Jiri Jarkovsky  16   17
Affiliations

The impact of cardiogenic shock and out-of-hospital cardiac arrest on the outcome of acute myocardial infarction: a national-level analysis

Pavol Tomasov et al. Intern Emerg Med. 2025 Aug.

Abstract

Cardiogenic shock (CS) and out-of-hospital cardiac arrest (OHCA) are events with profound implications for patient outcomes. We aim to analyze the predictors of CS and OHCA in patients with acute myocardial infarction and their effects on mortality. The analysis is based on data from a national registry between 2016 and 2020. A total of 23,703 patients with ST-elevation myocardial infarction (STEMI) were analyzed: (A) patients without CS and OHCA (19,590), (B) after OHCA (2,262), (C) with CS (713), and (D) after OHCA with CS (1,138). Patients after OHCA without CS had the lowest mean age [62.0 (± 12.6) years], while patients with CS without OHCA were the oldest [68.8 (± 11.8) years] and had the highest proportions of comorbidities. CS was a predictor of 30-day and 1-year mortality, with odds ratios [OR; 95% confidence intervals (CI)] of 5.52 (4.51; 6.75) and 4.66 (3.87; 5.61) for patients after OHCA, and OR (95% CI) 9.28 (7.56; 11.38) and 7.33 (6.04; 8.89) for those without OHCA. For overall survival up to 30 days and in comparison to patients without CS and OHCA, the hazard ratios (95% CI) was 2.77 (2.40; 3.20) for patients with OHCA only, 14.36 (12.57; 16.40) for patients with CS only, and 16.96 (15.19; 18.92) for patients with both CS and OHCA. OHCA altered the 30-day mortality risk after STEMI for both patients with and without CS. CS is a predictor of both 30-day and 1-year mortality in patients with STEMI, irrespective of OHCA status.

Keywords: Acute myocardial infarction; Cardiogenic shock; Out-of-hospital cardiac arrest; Outcome; Predictors.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that they have no competing interests. Ethics approval and consent to participate: Data in the NHIS are collected in accordance with Act No. 372/2011 Coll., on Health Services and Conditions of Their Provision. Due to this legal mandate, the retrospective analyses did not require either approval from an ethics committee or informed consent from participants. The investigation conforms to the principles outlined in the Declaration of Helsinki. Consent for publication: Not applicable.

Figures

Fig. 1
Fig. 1
Flowchart of the study
Fig. 2
Fig. 2
A Mortality of patients according to cardiogenic shock and out-of-hospital cardiac arrest (30 days). B Mortality of patients according to cardiogenic shock and out-of-hospital cardiac arrest (1 year). C Mortality of patients according to cardiogenic shock and out-of-hospital cardiac arrest (landmark analysis 30 days and 31 days–1 year)
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