[Predictors of short term mortality in patients with acute ST-elevation myocardial infarction complicated by cardiogenic shock].
OBJECTIVE
To explore the independent risk factors associated with short term mortality in patients with ST-segment elevation acute myocardial infarction (STEMI) complicated by cardiogenic shock (CS).


METHODS
We analyzed data from Chinese patients with ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock enrolled in the CREATE trial. Predictors of 30-day mortality were identified by univariate and multivariate logistic regression analysis using baseline and procedural variables.


RESULTS
The overall 30-day mortality of STEMI complicated by CS among the 517 patients [(68.5 ± 10.3) years and 57.6% male] was 62.3%. Logistic regression analysis showed that the independent risk factors of death included age (OR = 1.46, 95%CI: 1.18 - 1.81), anterior infarction (OR = 2.01, 95%CI 1.29 - 3.11), admission glucose level > 7.8 mmol/L (OR = 2.17, 95%CI: 1.26 - 3.73), serum sodium concentration < 130 mmol/L (OR = 2.21, 95%CI: 1.21 - 4.04), left ventricular ejection fraction (LVEF) < 40% or sever left ventricular dysfunction (LVD) (OR = 3.78, 95%CI: 2.28 - 6.27), no emergency revascularization (OR = 3.53, 95%CI: 1.20 - 10.41) and diuretics use (OR = 1.90, 95%CI: 1.21 - 2.97). Analysis using baseline clinical variables showed that the first five risk factors mentioned above were also the baseline risk factors fro death. The receiver operating characteristic curve for predicting the death of the two models was 0.81 (95%CI: 0.77 - 0.86) and 0.80 (95%CI: 0.75 - 0.84), respectively.


CONCLUSIONS
The 30-day mortality of patients with STEMI complicated by CS was over 60%. Age, anterior infarction, admission glucose level >7.8 mmol/L, serum sodium concentration < 130 mmol/L, left ventricular ejection fraction (LVEF) < 40% and no emergency revascularization were independent risk factors associated with 30-day mortality.
Department of Emergency, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Yao
Y
Liu
Jun
J
Zhu
Hui-Qiong
HQ
Tan
Yan
Y
Liang
Li-Sheng
LS
Liu
Ying
Y
Li
D000368:Aged; D002681:China; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D015996:Survival Rate; D016896:Treatment Outcome