In-hospital outcomes following primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction and cardiogenic shock: A single-center experience.

Abstract

Objective: To evaluate in-hospital outcomes subsequent to primary percutaneous coronary intervention (PCI) among individuals exhibiting ST-elevation myocardial infarction (STEMI) presenting with cardiogenic shock (CS). Study Design: Analytical Cross-sectional Analysis. Setting: Faisalabad Institute of Cardiology, Faisalabad. Period: April to October 2024. Methods: In total 145 patients within the age range of 30–65 years diagnosed with STEMI complicated by CS undergoing primary PCI were included. Baseline demographics, cardiovascular risk profile, clinical presentation, and angiographic characteristics were recorded. In-hospital outcomes, including mortality, arrhythmias, and contrast-induced nephropathy (CIN), were assessed. Statistical evaluation was performed using SPSS version 26, applying chi-square and binary logistic regression tests. Results: The mean age was 53.6±7 years, with 62.8% males. Hypertension, diabetes, smoking, and dyslipidemia were present in 60.7%, 42.8%, 49%, and 47.6% of patients, respectively. The most common culprit artery was proximal LAD (39.3%). Multivessel disease was observed in 66.2% of patients. In-hospital complications included arrhythmias in 12.3%, CIN in 22.8%, reinfarction in 6.2%, stroke in 2.8%, and major bleeding in 7.6% of patients. In-hospital mortality was observed at 8.3%. CIN showed a significant association with the number of diseased vessels (p=0.027) and culprit artery (p=0.039). On multivariable analysis, CIN (AOR=3.4, p=0.021) and triple vessel disease (AOR=2.8, p=0.034) emerged as independent determinants of mortality. Conclusion: Primary PCI in STEMI patients experiencing CS is characterized by notable in-hospital complications and mortality. Angiographic complexity and renal complications significantly influence outcomes, emphasizing the need for early risk stratification and optimized management strategies.