Abstract
Cardiogenic shock (CS) complicates 3-13% of acute myocardial infarction (AMI) cases, with a mortality rate of approximately 40% within the first 30 days, making it the leading cause of death in AMI patients. AMI accounts for 81% of CS cases. Pharmacological therapies, including inotropic agents with vasoactive and vasopressor effects, are commonly administered in these cases.
This study aimed to examine the relationship between inotropic therapy administered to patients with CS post-AMI and their mortality outcomes.
We conducted a prospective cross-sectional study from March 20 to October 20, 2024. Patients admitted with acute coronary syndrome (STEMI or NSTEMI) were evaluated, and those who developed CS were included in the study. Participants were categorized into two groups based on outcomes: a mortality group and a survival group.
Among 1,166 patients admitted for acute coronary syndrome at the Clinic of Cardiology over the seven-month study period, 86 (7.4%) developed CS. Of these, 44 patients (51%) died. Table 1 compares the two groups with respect to the inotropic agents administered. Significant differences were observed in the number of inotropic agents used, with 52% of survivors receiving only one inotropic agent, compared to 20.5% in the mortality group (p=0.002). Additionally, patients who received noradrenaline more frequently and at higher doses were predominantly in the mortality group, as shown in Table 1. Variables with statistical significance were included in a multiple regression model (Table 2a), which showed statistical significance (p=0.02), indicating that patients receiving more than one inotropic agent, or noradrenaline at higher doses, were at a higher risk of mortality. Noradrenaline dose was identified as an independent predictor of mortality (Table 2b).
Author notes
Funding Acknowledgements: None.
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