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. 2025 Sep 9;4(10Part A):103926.
doi: 10.1016/j.jscai.2025.103926. eCollection 2025 Oct.

Contemporary Management of ST-Elevation Myocardial Infarction-Related Cardiogenic Shock in New York: A Multicenter Registry

Abduljabar Adi  1   2   3 , Ramsis Ramsis  1   3 , Emily Rodriguez  1   3 , Daniel Miklin  1   4 , Jack Jnani  1   4 , Allan Lin  1   4 , Atul D Bali  1   5 , Sandrine Lebrun  1   5 , Arber Kodra  1   5 , Matthew Griffin  1   4 , Matthew Pierce  1   4 , Miguel Alvarez Villela  1   5
Affiliations

Contemporary Management of ST-Elevation Myocardial Infarction-Related Cardiogenic Shock in New York: A Multicenter Registry

Abduljabar Adi et al. J Soc Cardiovasc Angiogr Interv. .

Abstract

Background: Early revascularization improves survival in patients with ST-elevation myocardial infarction-related cardiogenic shock (STEMI-CS). However, lower rates of invasive management are seen in states with public reporting of outcomes for percutaneous coronary intervention and coronary artery bypass grafting surgery. The reasons for this remain speculative. We aim to report contemporary treatment patterns and examine the reasons for deferral of invasive management in patients with STEMI-CS in a New York cohort.

Methods: All patients with STEMI-CS in the Northwell-Shock Registry, a retrospective study of cardiogenic shock across 11 hospitals in New York, treated between January 2016 and August 2022, were included. Clinical variables and outcomes were compared between patients managed invasively and conservatively. Reasons for deferral of invasive management were collected manually from clinical documentation. Multivariable logistic regression was performed to examine the factors associated with a conservative management strategy.

Results: Invasive management was performed in 87% of patients, revascularization with percutaneous coronary intervention in 63% and coronary artery bypass grafting surgery in 8%. Hospital mortality was 27% for patients managed invasively and 81% for those managed conservatively. The most cited reasons for deferring invasive management were unclear neurologic status (35%), patient or family preference (29%), and complicating medical conditions (25%). Meanwhile, the factors independently associated with conservative management were older age, higher creatinine, cardiac arrest, and higher Society for Cardiovascular Angiography & Interventions (SCAI) stages.

Conclusions: Although rates of invasive management were high in this contemporary cohort of STEMI-CS patients in New York, risk aversion seems to still play a role in the deferral of invasive management in many patients.

Keywords: ST-elevation myocardial infarction; cardiogenic shock; invasive management; left heart catheterization; percutaneous coronary intervention; revascularization.

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Figures

Figure 1
Figure 1
Flowchart of study participants. CABG, coronary artery bypass grafting; LHC, left heart catheterization; PCI, percutaneous coronary intervention; STEMI, ST-elevation myocardial infarction.
Figure 2
Figure 2
Forest plot for factors associated with invasive management. Factors independently associated with invasive management were increasing age, admission with cardiac arrest, higher CSWG-SCAI stage on admission, higher baseline creatinine, and diabetes mellitus. ALT, alanine aminotransferase; CCI, Charlson comorbidity index; CSWG, Cardiogenic Shock Working Group; SCAI, Society for Cardiovascular Angiography & Interventions; WBC, white blood cell count.
Figure 3
Figure 3
Mortality according to treatment strategy by presenting Society for Cardiovascular Angiography & Interventions stage. Mortality was significantly higher in patients receiving conservative management after presenting with Society for Cardiovascular Angiography & Interventions stages of B, D, and E, and was numerically higher for those with stages A and C.
Figure 4
Figure 4
Mortality according to the reason for deferral of invasive management. Mortality rates varied based on the reasons for deferring left heart catheterization (LHC) and percutaneous coronary intervention (PCI). The highest mortality rates were observed in patients deferred due to neurologic dysfunction and patient or family preferences, followed by patients conservatively managed because of complicating concomitant conditions. CABG, coronary artery bypass grafting; CTO, chronic total occlusion.
Central Illustration
Central Illustration
Contemporary management of ST-elevation myocardial infarction (STEMI)-related cardiogenic shock in the New York metropolitan area. CTO, chronic total occlusion; LHC, left heart catheterization; PCI, percutaneous coronary intervention; SCAI, Society for Cardiovascular Angiography & Interventions.
See this image and copyright information in PMC

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