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

Published:September 18, 2022DOI:https://doi.org/10.1016/j.cardfail.2022.08.012

      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.

      ABSTRACT

      Objectives

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

      Background

      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.

      Conclusions

      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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