Contemporary Management of ST-Elevation Myocardial Infarction-Related Cardiogenic Shock in New York: A Multicenter Registry.
Publication/Presentation Date
10-1-2025
Abstract
BACKGROUND: Early revascularization improves survival in patients with ST-elevation myocardial infarction-related cardiogenic shock (STEMI-CS). However, lower rates of invasive management are seen in states with public reporting of outcomes for percutaneous coronary intervention and coronary artery bypass grafting surgery. The reasons for this remain speculative. We aim to report contemporary treatment patterns and examine the reasons for deferral of invasive management in patients with STEMI-CS in a New York cohort.
METHODS: All patients with STEMI-CS in the Northwell-Shock Registry, a retrospective study of cardiogenic shock across 11 hospitals in New York, treated between January 2016 and August 2022, were included. Clinical variables and outcomes were compared between patients managed invasively and conservatively. Reasons for deferral of invasive management were collected manually from clinical documentation. Multivariable logistic regression was performed to examine the factors associated with a conservative management strategy.
RESULTS: Invasive management was performed in 87% of patients, revascularization with percutaneous coronary intervention in 63% and coronary artery bypass grafting surgery in 8%. Hospital mortality was 27% for patients managed invasively and 81% for those managed conservatively. The most cited reasons for deferring invasive management were unclear neurologic status (35%), patient or family preference (29%), and complicating medical conditions (25%). Meanwhile, the factors independently associated with conservative management were older age, higher creatinine, cardiac arrest, and higher Society for Cardiovascular Angiography & Interventions (SCAI) stages.
CONCLUSIONS: Although rates of invasive management were high in this contemporary cohort of STEMI-CS patients in New York, risk aversion seems to still play a role in the deferral of invasive management in many patients.
Volume
4
Issue
10Part A
First Page
103926
Last Page
103926
ISSN
2772-9303
Published In/Presented At
Adi, A., Ramsis, R., Rodriguez, E., Miklin, D., Jnani, J., Lin, A., Bali, A. D., Lebrun, S., Kodra, A., Griffin, M., Pierce, M., & Alvarez Villela, M. (2025). Contemporary Management of ST-Elevation Myocardial Infarction-Related Cardiogenic Shock in New York: A Multicenter Registry. Journal of the Society for Cardiovascular Angiography & Interventions, 4(10Part A), 103926. https://doi.org/10.1016/j.jscai.2025.103926
Disciplines
Medicine and Health Sciences
PubMedID
41268076
Department(s)
Fellows and Residents
Document Type
Article