Clinical outcomes according to ECG presentations in infarct-related cardiogenic shock in CULPRIT-SHOCK - Sorbonne Université Access content directly
Journal Articles Chest Year : 2020

Clinical outcomes according to ECG presentations in infarct-related cardiogenic shock in CULPRIT-SHOCK

Kurt Huber
Stéphanie Rouanet
  • Function : Author
Stefano Savonitto
Eric Vicaut
Stephan Windecker
Uwe Zeymer

Abstract

BackgroundThe impact of ECG presentations of acute myocardial infarction (AMI) in cardiogenic shock is unknown.Research questionIn myocardial infarction with cardiogenic shock, is there a difference in the outcomes and effect of revascularization strategies between non-ST-segment elevation myocardial infarction (NSTE-MI) and left bundle branch block (LBBB-MI) versus STEMI?MethodsCardiogenic shock patients from the CULPRIT-SHOCK trial presenting with NSTE-MI or LBBB-MI were compared with STE-MI patients for 30-day and 1-year all-cause mortality. The interaction between ECG presentation and the effect of revascularization strategies on outcomes was evaluated.ResultsOf 665 cardiogenic shock patients analyzed, 55.9% presented with STE-MI, 29.3% with NSTE-MI and 14.7% with LBBB-MI. Patients differed in age (68.0 years in STE-MI, 71.0 years in NSTE-MI and 73.5 years in LBBB-MI, p=0.015), cardiovascular risk factors and angiographic severity. There was no difference in the 30-day risk of death between NSTE-MI and STE-MI (48.7 % vs. 43.0%, aOR 1.05, 95%CI, 0.66 - 1.67, p=0.85), nor between LBBB-MI and STE-MI (59.2% vs. 43.0%, aOR 1.31, 95%CI 0.73 - 2.34, p=0.36). While the univariate risk of 1-year death was higher in NSTE-MI and LBBB-MI patients compared with STE-MI, ECG presentation was not an independent risk factor of mortality after adjustment (NSTE-MI vs. STE-MI : 56.4 % vs 46.8 % aOR 1.21, 95%CI 0.76 - 1.92, p=0.42 ; LBBB-MI vs. STEMI : 69.4% vs. 46.8% : aOR : 1.59, 95%CI 0.89 – 2.84, p=0.12) . ECG presentation did not modify the effect of the revascularization strategy on 30-day and 1-year mortality (p interaction =0.91 and 0.97).InterpretationIn patients with cardiogenic shock, NSTE-MI and LBBB-MI presentations reflect higher risk profiles than STE-MI but are not independent risk factors of mortality. ECG presentations did not modify the treatment effect, supporting culprit-lesion-only PCI as the preferred strategy across the AMI spectrum.
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Dates and versions

hal-03101339 , version 1 (24-04-2023)

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Attribution - NonCommercial

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Michel Zeitouni, Ibrahim Akin, Steffen Desch, Olivier Barthelemy, Delphine Brugier, et al.. Clinical outcomes according to ECG presentations in infarct-related cardiogenic shock in CULPRIT-SHOCK. Chest, 2020, ⟨10.1016/j.chest.2020.10.089⟩. ⟨hal-03101339⟩
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