Mortality and Heart Failure Hospitalization Among Young Adults With and Without Cardiogenic Shock After Acute Myocardial Infarction

Published:September 18, 2022DOI:

      Bullet Points

      • Among patients who experience a myocardial infarction (MI) at or below the age of 50, 7% developed cardiogenic shock.
      • Significant factors associated with cardiogenic shock in young patients with MI (AMI-CS) included ST-elevation MI, left main disease, cardiac arrest, female sex, peripheral vascular disease, and diabetes.
      • Patients with AMI-CS had significantly worse all-cause mortality rates, cardiovascular mortality and 1-year hospitalization for heart failure.



      To investigate risk factors and outcomes of cardiogenic shock complicating acute myocardial infarction (AMI-CS) in young patients with AMI.


      AMI-CS is associated with high morbidity and mortality rates. Data regarding AMI-CS in younger individuals are limited.

      Methods and Results

      Consecutive patients with type 1 AMI aged 18–50 years admitted to 2 large tertiary-care academic centers were included, and they were adjudicated as having cardiogenic shock (CS) by physician review of electronic medical records using the Society for Cardiovascular Angiography and Interventions CS classification system. Outcomes included all-cause mortality (ACM), cardiovascular mortality (CVM) and 1-year hospitalization for heart failure (HHF). In addition to using the full population, matching was also used to define a comparator group in the non-CS cohort. Among 2097 patients (mean age 44 ± 5.1 years, 74% white, 19% female), AMI-CS was present in 148 (7%). Independent risk factors of AMI-CS included ST-segment elevation myocardial infarction, left main disease, out-of-hospital cardiac arrest, female sex, peripheral vascular disease, and diabetes. Over median follow-up of 11.2 years, young patients with AMI-CS had a significantly higher risk of ACM (adjusted HR 2.84, 95% CI 1.68–4.81; P < 0.001), CVM (adjusted HR 4.01, 95% CI 2.17–7.71; P < 0.001), and 1-year HHF (adjusted HR 5.99, 95% CI 2.04–17.61; P = 0.001) compared with matched non-AMI-CS patients. Over the course of the study, there was an increase in the incidence of AMI-CS among young patients with MI as well as rising mortality rates for patients with both AMI-CS and non-AMI-CS.


      Of young patients with AMI, 7% developed AMI-CS, which was associated with a significantly elevated risk of mortality and HHF.

      Graphical Abstract

      Key Words

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        • Aissaoui N
        • Puymirat E
        • Delmas C
        • Ortuno S
        • Durand E
        • Bataille V
        • et al.
        Trends in cardiogenic shock complicating acute myocardial infarction.
        Eur J Heart Fail. 2020; 22: 664-672
        • De Luca L
        • Olivari Z
        • Farina A
        • Gonzini L
        • Lucci D
        • Di Chiara A
        • et al.
        Temporal trends in the epidemiology, management, and outcome of patients with cardiogenic shock complicating acute coronary syndromes: management changes in cardiogenic shock.
        Eur J Heart Fail. 2015; 17: 1124-1132
        • Babaev A
        • Frederick PD
        • Pasta DJ
        • Every N
        • Sichrovsky T
        • Hochman JS
        NRMI Investigators. Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock.
        JAMA. 2005; 294: 448
        • Berg DD
        • Bohula EA
        • Morrow DA.
        Berg DD, Bohula EA, Morrow DA. Epidemiology and causes of cardiogenic shock.
        Curr Opin Crit Care. 2021; 27: 401-408
        • Goldberg RJ
        • Samad NA
        • Yarzebski J
        • Gurwitz J
        • Bigelow C
        • Gore JM.
        Temporal trends in cardiogenic shock complicating acute myocardial infarction.
        N Engl J Med. 1999; 340: 1162-1168
        • Kolte D
        • Khera S
        • Aronow WS
        • Mujib M
        • Palaniswamy C
        • Sule S
        • et al.
        Trends in incidence, management, and outcomes of cardiogenic shock complicating ST-elevation myocardial infarction in the United States.
        JAHA. 2014; 3: 1-17
        • Singh A
        • Collins B
        • Qamar A
        • Gupta A
        • Fatima A
        • Divakaran S
        • et al.
        Study of young patients with myocardial infarction: design and rationale of the YOUNG-MI Registry.
        Clin Cardiol. 2017; 40: 955-961
        • Singh A
        • Collins BL
        • Gupta A
        • Fatima A
        • Qamar A
        • Biery D
        • et al.
        Cardiovascular risk and statin eligibility of young adults after an MI.
        J Am Coll Cardiol. 2018; 71: 292-302
        • Singh A
        • Gupta A
        • DeFilippis EM
        • Qamar A
        • Biery DW
        • Almarzooq Z
        • et al.
        Cardiovascular mortality after type 1 and type 2 myocardial infarction in young adults.
        J Am Coll Cardiol. 2020; 75: 1003-1013
        • Berman AN
        • Biery DW
        • Ginder C
        • Singh A
        • Baek J
        • Wadhera RK
        • et al.
        Association of socioeconomic disadvantage with long-term mortality after myocardial infarction: the Mass General Brigham YOUNG-MI Registry.
        JAMA Cardiol. 2021; 6: 880-888
        • Kind AJH
        • Jencks S
        • Brock J
        • Yu M
        • Bartels C
        • Ehlenbach W
        • et al.
        Neighborhood socioeconomic disadvantage and 30-day rehospitalization: a retrospective cohort study.
        Ann Intern Med. 2014; 161: 765-774
        • Baran DA
        • Grines CL
        • Bailey S
        • Burkhoff D
        • Hall SA
        • Henry TD
        • et al.
        SCAI clinical expert consensus statement on the classification of cardiogenic shock: this document was endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), the Society of Critical Care Medicine (SCCM), and the Society of Thoracic Surgeons (STS) in April 2019.
        Catheter Cardiovasc Interv. 2019; 94: 29-37
        • Naidu SS
        • Baran DA
        • Jentzer JC
        • Hollenberg SM
        • van Diepen S
        • Basir MB
        • et al.
        SCAI SHOCK stage classification expert consensus update: a review and incorporation of validation studies.
        J Soc Cardiovasc Angiogr Intervent. 2022; 79: 933-946
        • Thayer KL
        • Zweck E
        • Ayouty M
        • Garan AR
        • Hernandez-Montfort J
        • Mahr C
        • et al.
        Invasive hemodynamic assessment and classification of in-hospital mortality risk among patients with cardiogenic shock.
        Circ: Heart Fail. 2020; 13: 334-349
        • Hicks KA
        • Tcheng JE
        • Bozkurt B
        • Chaitman BR
        • Cutlip DE
        • Farb A
        • et al.
        ACC/AHA key data elements and definitions for cardiovascular endpoint events in clinical trials.
        J Am Coll Cardiol 2015. 2014; 66: 403-469
        • Stuart EA.
        Matching methods for causal inference: a review and a look forward.
        Statist Sci. 2010; 25: 1-21
        • Auffret V
        • Cottin Y
        • Leurent G
        • Gilard M
        • Beer J-C
        • Zabalawi A
        • et al.
        • ORBI and RICO Working Groups
        Predicting the development of in-hospital cardiogenic shock in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: the ORBI risk score.
        Eur Heart J. 2018; 39: 2090-2102
        • DeFilippis EM
        • Collins BL
        • Singh A
        • Biery DW
        • Fatima A
        • Qamar A
        • et al.
        Women who experience a myocardial infarction at a young age have worse outcomes compared with men: the Mass General Brigham YOUNG-MI registry.
        Eur Heart J. 2020; 41: 4127-4137
        • Vallabhajosyula S
        • Ya'Qoub L
        • Singh M
        • Bell MR
        • Gulati R
        • Cheungpasitporn W
        • et al.
        Sex disparities in the management and outcomes of cardiogenic shock complicating acute myocardial infarction in the young.
        Circ: Heart Fail. 2020; 13: 437-445
        • Vallabhajosyula S
        • Dunlay SM
        • Hayes SN
        • Best PJM
        • Brenes-Salazar JA
        • Lerman A
        • et al.
        Sex and gender disparities in the management and outcomes of acute myocardial infarction–cardiogenic shock in older adults.
        Mayo Clin Proceed. 2020; 95: 1916-1927
        • Arora S
        • Stouffer GA
        • Kucharska-Newton AM
        • Qamar A
        • Vaduganathan M
        • Pandey A
        • et al.
        Twenty-year trends and sex differences in young adults hospitalized with acute myocardial infarction: the ARIC Community Surveillance Study.
        Circulation. 2019; 139: 1047-1056
        • Bangalore S
        • Fonarow GC
        • Peterson ED
        • Hellkamp AS
        • Hernandez AF
        • Laskey W
        • et al.
        Age and gender differences in quality of care and outcomes for patients with ST-segment elevation myocardial infarction.
        Am J Med. 2012; 125: 1000-1009
        • Kolte D
        • Khera S
        • Dabhadkar KC
        • Agarwal S
        • Aronow WS
        • Timmermans R
        • et al.
        Trends in coronary angiography, revascularization, and outcomes of cardiogenic shock complicating non-ST-elevation myocardial infarction.
        Am J Cardiol. 2016; 117: 1-9
        • Gupta T
        • Kolte D
        • Khera S
        • Agarwal N
        • Villablanca PA
        • Goel K
        • et al.
        Contemporary Sex-based differences by age in presenting characteristics, use of an early invasive strategy, and inhospital mortality in patients with non–ST-segment–elevation myocardial infarction in the United States.
        Circ Cardiovasc Interv. 2018; 11: 1-9
        • Goldberg RJ
        • Spencer FA
        • Gore JM
        • Lessard D
        • Yarzebski J.
        Thirty-year trends (1975 to 2005) in the magnitude of, management of, and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: a population-based perspective.
        Circulation. 2009; 119: 1211-1219
        • Harjola V-P
        • Lassus J
        • Sionis A
        • Køber L
        • Tarvasmäki T
        • Spinar J
        • et al.
        • for the CardShock study investigators and the GREAT network
        Clinical picture and risk prediction of short-term mortality in cardiogenic shock: clinical picture and outcome of cardiogenic shock.
        Eur J Heart Fail. 2015; 17: 501-509
        • Padkins M
        • Breen T
        • Anavekar N
        • Diepen S
        • Henry TD
        • Baran DA
        • et al.
        Age and shock severity predict mortality in cardiac intensive care unit patients with and without heart failure.
        ESC Heart Fail. 2020; 7: 3971-3982
        • Kanwar M
        • Thayer KL
        • Garan AR
        • Hernandez-Montfort J
        • Whitehead E
        • Mahr C
        • et al.
        Impact of age on outcomes in patients with cardiogenic shock.
        Front Cardiovasc Med. 2021; 8: 1-8
        • Lauridsen MD
        • Rorth R
        • Butt JH
        • Kristensen SL
        • Schmidt M
        • Moller JE
        • et al.
        Five-year risk of heart failure and death following myocardial infarction with cardiogenic shock: a nationwide cohort study.
        Eur Heart JAcute Cardiovasc Care. 2021; 10: 40-49
        • Lawler PR
        • Berg DD
        • Park J-G
        • Katz JN
        • Baird-Zars VM
        • Barsness GW
        • et al.
        The range of cardiogenic shock survival by clinical stage: data from the Critical Care Cardiology Trials Network Registry.
        Crit Care Med. 2021; 49: 1293-1302
        • Virani SS
        • Alonso A
        • Aparicio HJ
        • Benjamin EJ
        • Bittencourt MS
        • Callaway CW
        • et al.
        • on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee
        Heart disease and stroke statistics: 2021 update: a report from the American Heart Association.
        Circulation. 2021; 143: e254-e743