Risk stratification in acute myocardial infarction-related cardiogenic shock (AMICS) remains challenging, particularly among patients presenting with out-of-hospital cardiac arrest (OHCA). A registry-based analysis published in the Journal of Cardiac Failure evaluated whether OHCA characteristics and intubation status influenced 30-day mortality risk in patients with AMICS undergoing percutaneous coronary intervention (PCI).
The study analyzed data from the Netherlands Heart Registration collected between 2017 and 2021 across 14 hospitals. Patients were categorized into 3 groups: AMICS without OHCA, favorable AMICS-OHCA, and unfavorable AMICS-OHCA. Favorable OHCA was defined as witnessed arrest with return of spontaneous circulation within 30 minutes.
The primary endpoint was 30-day mortality evaluated using multivariable Cox regression analysis. Investigators also assessed the association between intubation and mortality across all subgroups.
Findings
- The analysis included 2,226 patients, including 1,313 with AMICS without OHCA, 490 with favorable AMICS-OHCA, and 423 with unfavorable AMICS-OHCA.
- Favorable AMICS-OHCA was associated with lower adjusted 30-day mortality risk compared with AMICS without OHCA (hazard ratio [HR] 0.74; 95% CI 0.59-0.92).
- Unfavorable AMICS-OHCA was associated with higher adjusted 30-day mortality risk (HR 1.31; 95% CI 1.06-1.63).
- Intubation was independently associated with higher 30-day mortality across all patient subgroups.
Patients with favorable and unfavorable OHCA characteristics showed substantially different mortality risk profiles after PCI for AMICS. The findings suggest OHCA should not be treated as a simple binary modifier in shock classification and support further evaluation of intubation as a prognostic marker.
