METHODS: We analyzed data from patients with AMICS presenting to multiple centers across the Gulf region between January 2020 and December 2022. Patients were grouped according to SCAI-Cardiogenic Shock Working Group classification: group 1 (SCAI shock stages B/C) and group 2 (SCAI shock stages D/E). Primary end points were survival at 6, 12, 18, and 24 months. Both univariate and multivariate statistical methods were employed in the analysis.
RESULTS: A total of 1513 patients from the Gulf Cardiogenic Shock registry, were included with 31.1% in group 1 and 68.9% in group 2. The median follow-up was 6 months. Survival rates in group 1 were 87%, 72%, 56%, and 48% at 6, 12, 18, and 24 months, respectively, whereas group 2 exhibited survival rates of 66%, 29%, 14%, and 4%, respectively, over the same periods. Survival progressively declined with advancing SCAI shock stages, with stage B having the highest survival rates and stage E the lowest (P < .001). Multivariable Cox regression analysis identified higher SCAI stages as strong predictors of increased mortality, with patients in group 2 having a more than 3-fold higher risk of mortality compared to those in group 1 (hazard ratio, 3.13; 95% CI, 2.40-4.07; P < .001). Additionally, lower left ventricular ejection fraction, advanced age, and the presence of tachyarrhythmias were associated with increased mortality risk.
CONCLUSIONS: This is the first study to validate SCAI-Cardiogenic Shock Working Group stages in a large cohort of patients with AMICS. The SCAI shock staging classification was significantly associated with higher short- and long-term mortality in this cohort, with patients in more advanced stages (D/E) experiencing markedly worse survival outcomes. These findings underscore the utility of SCAI staging in stratifying long-term risk among AMICS patients in the Gulf region. Identification of cardiogenic shock patients at SCAI stages D and E with early hemodynamic monitoring and treating them aggressively with newer mechanical circulatory support in the early stages may improve patient survival.
METHODS: The Gulf-CS registry included 1,513 patients with AMI-CS diagnosed between January 2020 and December 2022.
RESULTS: The incidence of AMI-CS was 4.1% (1513/37379). The median age was 60 years. The most common presentation was ST-elevation MI (73.83%). In-hospital mortality was 45.5%. Majority of patients were in SCAI stage D and E (68.94%). Factors associated with hospital mortality were previous coronary artery bypass graft (OR:2.49; 95%CI: 1.321-4.693), cerebrovascular accident (OR:1.621, 95%CI: 1.032-2.547), chronic kidney disease (OR:1.572; 95%CI1.158-2.136), non-ST-elevation MI (OR:1.744; 95%CI: 1.058-2.873), cardiac arrest (OR:5.702; 95%CI: 3.640-8.933), SCAI stage D and E (OR:19.146; 95CI%: 9.902-37.017), prolonged QRS (OR:10.012; 95%CI: 1.006-1.019), right ventricular dysfunction (OR:1.679; 95%CI: 1.267-2.226) and ventricular septal rupture (OR:6.008; 95%CI: 2.256-15.998). Forty percent had invasive hemodynamic monitoring, 90.02% underwent revascularization, and 45.80% received mechanical circulatory support (41.31% had Intra-Aortic Balloon Pump and 14.21% had Extracorporeal Membrane Oxygenation/Impella devices). Survival at 12 months was 51.49% (95% CI: 46.44- 56.29%).
CONCLUSIONS: The study highlighted the significant burden of AMI-CS in this region, with high in-hospital mortality. The study identified several key risk factors associated with increased hospital mortality. Despite the utilization of invasive hemodynamic monitoring, revascularization, and mechanical circulatory support in a substantial proportion of patients, the 12-month survival rate remained relatively low.