Acute myocardial infarction complicated by shock: outcome analysis based on initial electrocardiogram.
OBJECTIVE
To assess the relation between initial ECG findings, presence of risk factors, coronary angiography findings, and clinical outcomes in patients with acute myocardial infarction complicated by cardiogenic shock (CS).


METHODS
Data from a total of 5572 acute myocardial infarction patients admitted to the four tertiary hospitals during a period of 3 years were analyzed. CS on admission was present in 358 patients (6.4%). They were divided into four groups based on the admission ECG: ST-segment elevation (STEMI), ST-segment depression (STDMI), bundle branch block (BBBMI), and other ECG acute myocardial infarction.


RESULTS
CS developed most frequently among BBBMI patients (in 12.1% of all BBBMIs, p < 0.001 vs. STEMI), followed by STEMI (6.7%), STDMI (4.4%), and other ECG acute myocardial infarction (2.3%). The risk of CS development was similar in patients with left bundle branch block (LBBB) (13.3%) and right bundle branch block (RBBB) (11.2%). The one-year mortality was highest among RBBBMI patients (66.7%, p < 0.001), followed by LBBBMI (48.6%), other ECG (47.1%), STEMI (41.7%), and STDMI patients (38.1%).


CONCLUSIONS
RBBB on admission ECG is associated with the highest risk of CS development, frequent left main coronary artery affection, and unsuccessful revascularization. It is also an independent predictor of one-year mortality.
1st Department of Internal Medicine - Cardioangiology, University Hospital Hradec Kralove , Czech Republic.
Martin
M
Jakl
Josef
J
Stasek
Petr
P
Kala
Richard
R
Rokyta
Jan
J
Kanovsky
Tomas
T
Ondrus
Milan
M
Hromadka
Petr
P
Widimsky
D000368:Aged; D002037:Bundle-Branch Block / Q000150:complications / Q000175:diagnosis; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D018153:Czech Republic / Q000453:epidemiology; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D062606:Tertiary Care Centers; D013997:Time Factors