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Reperfusion Therapy for St-Elevation Myocardial Infarction Complicated by Cardiogenic Shock: The European Society of Cardiology Eurobservational Programme Acute Cardiovascular Care-European Association of Pci St-Elevation Myocardial Infarction Registry Publisher



Zeymer U1 ; Ludman P2 ; Danchin N3 ; Kala P4 ; Laroche C5 ; Gale CP6 ; Maggioni AP5, 7 ; Siabani S8 ; Sadeghi M9 ; Wafa A10 ; Bartus S11 ; Weidinger F12
Authors
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Authors Affiliations
  1. 1. Klinikum der Stadt Ludwigshafen and Institut fur Herzinfarktforschung, Ludwigshafen am Rhein, Germany
  2. 2. Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
  3. 3. Hopital Europeen G. Pompidou, Service de Cardiologie, Paris, France
  4. 4. Internal Cardiology Department, Faculty of Medicine of Masaryk University, University Hospital Brno, Brno, Czech Republic
  5. 5. EURObservational Research Program, European Society of Cardiology, Sophia-Antipolis, France
  6. 6. Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
  7. 7. Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
  8. 8. Kermanshah University of Medical Sciences, Kermanshah, Iran
  9. 9. Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
  10. 10. Mansoura Faculty of Medicine, Cardiology department, Mansoura, Egypt
  11. 11. Department of Cardiology, Jagiellonian University, Krakow, Poland
  12. 12. Hospital Rudolfstiftung, Vienna, Austria

Source: European Heart Journal: Acute Cardiovascular Care Published:2022


Abstract

Aims: To determine the current state of the use of reperfusion and adjunctive therapies and in-hospital outcomes in European Society of Cardiology (ESC) member and affiliated countries for patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS). Methods and results: ESC EurObservational Research Programme prospective international cohort study of admissions with STEMI within 24 h of symptom onset (196 centres; 26 ESC member and 3 affiliated countries). Of 11 462 patients enrolled, 448 (3.9%) had CS. Patients with compared to patients without CS, less frequently received primary percutaneous coronary intervention (PCI) (65.5% vs. 72.2%) and fibrinolysis (15.9% vs. 19.0), and more often had no reperfusion therapy (19.0% vs. 8.5%). Mechanical support devices (intraaortic ballon pump 11.2%, extracoporeal membrane oxygenation 0.7%, other 1.1%) were used infrequently in CS. Bleeding definition academic research consortium 2-5 bleeding complications (10.1% vs. 3.0%, P < 0.01) and stroke (4.2% vs. 0.9%, P < 0.01) occurred more frequently in patients with CS. In-hospital mortality was 10-fold higher (35.5% vs. 3.1%) in patients with CS. Mortality in patients with CS in the groups with PCI, fibrinolysis, and no reperfusion therapy were 27.4%, 36.6%, and 62.4%, respectively. Conclusion: In this multi-national registry, patients with STEMI complicated by CS less frequently receive reperfusion therapy than patients with STEMI without CS. Early mortality in patients with CS not treated with primary PCI is very high. Therefore, strategies to improve clinical outcome in STEMI with CS are needed. © 2022 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved.
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