title: Cardiogenic Shock Predicts Long-term Mortality in Hospital Survivors of STEMI Treated With Primary Percutaneous Coronary Intervention.
abstract: BACKGROUND
  ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS) has a poor prognosis. Recently published data suggested, however, that CS does not affect long-term mortality in hospital survivors of STEMI. We investigated whether this could be confirmed in a larger cohort.
  
  
  OBJECTIVE
  STEMI complicated by CS leads to worse long-term survival.
  
  
  METHODS
  A prospective cohort study was performed in 7412 consecutive patients with STEMI treated by primary percutaneous coronary intervention (angioplasty). The predictive value of CS on long-term mortality was assessed in hospital survivors. Multivariate analysis, adjusting for differences in baseline variables, was performed to assess the independent prognostic value of CS.
  
  
  RESULTS
  Cardiogenic shock was observed in 387 patients (5.2%). The total in-hospital mortality was 254 (3.4%), and mortality was significantly higher in patients with CS (20.0% vs 2.6%; P < 0.001). The 1-year mortality in hospital survivors was 10.3% in patients with CS and 3.9% in patients without CS (P < 0.001). After multivariate analysis, CS was still a significant predictor of long-term mortality in hospital survivors (hazard ratio: 2.6, 95% confidence interval: 1.64-4.01).
  
  
  CONCLUSIONS
  Cardiogenic shock remains a strong predictor of long-term mortality in hospital survivors of STEMI treated by primary percutaneous coronary intervention.
authors: Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands.
authors: Veemal V
authors: http://orcid.org/0000-0002-9161-159X
authors: VV
authors: Hemradj
authors: Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands.
authors: Jan Paul
authors: JP
authors: Ottervanger
authors: Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands.
authors: Arnoud W
authors: AW
authors: van 't Hof
authors: Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands.
authors: Jan Henk
authors: JH
authors: Dambrink
authors: Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands.
authors: Marcel
authors: M
authors: Gosselink
authors: Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands.
authors: Elvin
authors: E
authors: Kedhi
authors: Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands.|Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors: Harry
authors: H
authors: Suryapranata
mesh_terms: D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Acute coronary syndrome; Ischemic heart disease; myocardial infarction