Natural history and risk factors of long-term mortality in acute coronary syndrome patients with cardiogenic shock

Abstract

Purpose: Cardiogenic shock (CS) is a severe complication of acute coronary syndromes (ACS). Intra-aortic balloon pump (IABP) is considered important mechanical therapy for acute CS. We aimed to analyze the natural history and possible prognostic factors in patients with CS complicating ACS.

Patients/methods: All 126 patients (mean age 65.8 ± 12.5 years), who were hospitalized in single center due to an episode of CS in the course of ACS, had IABP and were scheduled for coronary angiography. The assessed end-point was 5-year death from any cause.

Results: Median left ventricle ejection fraction (LVEF) 28% (interquartile range (IQR) 23-35%), 39 patients (31%) were female, in 91 (72%) the initial diagnosis was ST-elevation myocardial infarction (STEMI). Mean time on the IABP was 3.8 ± 3 days. During index hospitalization there were 56 deaths (44%). Other 27 patients (out of 70 discharged - 38.5%) died during 5-year follow-up. In univariate logistic regression, the significant effect on long term mortality had age, female gender, reduced ejection fraction below 31% and hypotension on admission. The out of hospital survival was also determined by age, gender and hypotension, while LVEF lost its predictive value The multivariate survival analysis both in whole group and in patients discharged from hospital was independently affected by age and hypotension on the admission.

Conclusions: The mortality of patients with CS despite treatment with IABP remains very high, especially during the in-hospital period and early after discharge. Among assessed parameters age and hypotension on the admission are the most important predictors of adverse long term prognosis.

Keywords: Acute coronary syndromes; Cardiogenic shock; IABP; Long term mortality; Prognosis.