Comparison of Outcomes between Early and Late Presentation of ST-elevation Myocardial Infarction in Patients with Cardiogenic Shock

Abstract

Background and Aim: Cardiogenic shock (CS) arising from ST-elevation myocardial infarction (STEMI) is associated with high mortality. This study aimed to evaluate the clinical characteristics and outcomes of early versus late-present patients with CS complicated with STEMI. Materials and Methods: This prospective observational study enrolled 92 patients with STEMI and CS from September 2020 to December 2021. Patients were divided into two groups based on the time from symptom onset to hospitalization: early (<24 hours, n=48) and late (≥24 hours, n=44). Demographic data, clinical characteristics, management strategies, and outcomes were compared between the two groups. The Society of Cardiovascular Angiography and Intervention was used to predict mortality between the groups. After one month of discharge outcomes like death, stroke, and non-fatal myocardial infarction were reported. Results: Most patients were male (70.7%) with a mean age of 63.4±10.9 years. Late presenters were more likely to have lower socioeconomic status and reside in rural areas. The late presentation group had a higher proportion of patients in advanced societies of cardiovascular angiography and intervention stages (D and E) compared with the early group. Late presenters had significantly higher rates of acute kidney injury (72.7% vs. 41.7%, p=0.003) and major adverse cardiovascular events (81.8% vs. 45.8%, p<0.001) at discharge, driven primarily by increased mortality, although the gap in mortality rates narrowed by one month. Conclusion: Early presentation of STEMI complicated by CS is associated with improved outcomes. Late presenters experienced higher rates of complications and mortality.

Keywords

• management
• mortality
• myocardial infarction
• shock
• cardiogenic
• st elevation myocardial infarction