Current Spectrum and Outcomes of Infarct-Related Cardiogenic Shock: Insights from the CULPRIT-SHOCK Registry and RCT.

Zeymer, Uwe; Heer, Tobias; Ouarrak, Taoufik; Akin, Ibrahim; Noc, Marko; Stepinska, Janina; Oldroyd, Keith; Serpytis, Pranas; Montalescot, Giles; Huber, Kurt; Windecker, Stephan; Savonitto, Stefano; Vrints, Christiaan; Schneider, Steffen; Desch, Steffen; Thiele, Holger (2024). Current Spectrum and Outcomes of Infarct-Related Cardiogenic Shock: Insights from the CULPRIT-SHOCK Registry and RCT. European Heart Journal: Acute Cardiovascular Care, 13(4), pp. 335-346. Sage 10.1093/ehjacc/zuae020

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BACKGROUND

We analysed consecutive patients with acute myocardial infarction complicated by cardiogenic shock (CS) who were enrolled into the CULPRIT-SHOCK randomized controlled trial (RCT) and those with exclusion criteria who were included into the accompanying registry.

METHODS

In total, 1,075 patients with infarct-related CS were screened for CULPRIT-SHOCK in 83 specialised centres in Europe; 369 of them had exclusion criteria for the RCT and were enrolled into the registry. Patients were followed over 1-year.

RESULTS

Mean age was 68 years and 260 (25 %) were women. 13.5 %, 30.9 %, and 55.6 % had 1-vessel, 2-vessel, and 3-vessel coronary artery disease (CAD), respectively. Significant left main (LM) coronary artery stenosis was present in 8.0 %. 54.2 % of the patients had cardiac arrest before admission. TIMI 3 patency of the infarct vessel after PCI was achieved in 83.6 % of all patients. Mechanical circulatory support was applied in one third of patients. Total mortality after 30 days and one year was 47.6 % and 52.9 %. Mortality after one year was highest in patients with LM coronary artery stenosis (63.5 %), followed by 3-vessel- (56.6 %), 2-vessel- (49.8 %), and 1-vessel-CAD (38.6 %), respectively. Mechanical complications were rare (21/1008; 2.1 %) but associated with a high mortality of 66.7 % after 1 year.

CONCLUSIONS

In specialised centres in Europe short- and long-term mortality of patients with infarct-related CS treated with an invasive strategy is still high and mainly depending on the extent of coronary artery disease. Therefore, there is still need for improvement of care to improve prognosis of infarct-related CS.

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