Pop Călin Florin, Coadă Camelia Alexandra, Lupu Mihai, Ferenț Ioan Florin, Hodas Roxana Ioana, Pintilie Andreea, Ursu Mădălina-Ştefana
Department of Cardiology, "Constantin Opriş" Emergency County Hospital, 430031 Baia Mare, Romania.
Faculty of Nursing and Health Sciences, University of Medicine and Pharmacy "Iuliu Hațieganu", 400012 Cluj-Napoca, Romania.
Medicina (Kaunas). 2025 Apr 14;61(4):725. doi: 10.3390/medicina61040725.
: ST elevation myocardial infarction (STEMI), particularly when complicated by cardiogenic shock (CS), is a critical condition associated with high mortality rates. Identifying predictors of in-hospital mortality can enhance patient management and outcomes. : This observational, retrospective case-control study included STEMI patients, both complicated and uncomplicated by CS. Additionally, demographics, clinical characteristics, laboratory data and in-hospital mortality rates were analysed for STEMI patients with CS and those without CS. : This study included a total of 101 patients with STEMI, of whom 51 (50.5%) had STEMI without CS and 50 (49.5%) had STEMI with CS. No significant differences were observed in demographic characteristics or STEMI risk factors between the two groups. Emergency coronarography was performed in 90.1% of the patients, with successful thrombolysis achieved in 24.5%. Patients with CS exhibited a significantly higher mortality (52%) than those without CS (11.76%). Univariate analysis identified white blood cell counts, CK-MB, CK levels, elevated creatinine and uric acid levels and a reduced left ventricular ejection fraction (LVEF) as predictors of mortality. Logistic regression analysis revealed that LVEF and CK-MB were independent predictors of in-hospital mortality in patients with STEMI and CS. Each 1% increase in LVEF was associated with a reduced mortality risk (HR = 0.89; 95% CI 0.81-0.98; = 0.018), while elevated CK-MB levels were linked to an increased mortality risk (HR = 1; 95% CI 1-1.01; = 0.014). : Reduced systolic function and elevated CK-MB levels are key predictors of in-hospital mortality and outcomes in STEMI patients with CS. These findings underscore the importance of early identification and support the development of targeted management strategies aimed at improving outcomes in this high-risk population.
ST段抬高型心肌梗死（STEMI），尤其是并发心源性休克（CS）时，是一种死亡率很高的危急病症。识别院内死亡的预测因素可改善患者管理及预后。
这项观察性、回顾性病例对照研究纳入了STEMI患者，包括并发和未并发CS的患者。此外，对并发CS和未并发CS的STEMI患者的人口统计学特征、临床特征、实验室数据及院内死亡率进行了分析。
本研究共纳入101例STEMI患者，其中51例（50.5%）为未并发CS的STEMI患者，50例（49.5%）为并发CS的STEMI患者。两组在人口统计学特征或STEMI危险因素方面未观察到显著差异。90.1%的患者接受了急诊冠状动脉造影，24.5%的患者溶栓成功。并发CS的患者死亡率（52%）显著高于未并发CS的患者（11.76%）。单因素分析确定白细胞计数、肌酸激酶同工酶（CK-MB）、肌酸激酶（CK）水平、肌酐和尿酸水平升高以及左心室射血分数（LVEF）降低为死亡的预测因素。逻辑回归分析显示，LVEF和CK-MB是STEMI并发CS患者院内死亡的独立预测因素。LVEF每增加1%，死亡风险降低（风险比[HR]=0.89；95%置信区间[CI]0.81-0.98；P=0.018），而CK-MB水平升高与死亡风险增加相关（HR=1；95%CI1-1.01；P=0.014）。
收缩功能降低和CK-MB水平升高是STEMI并发CS患者院内死亡及预后的关键预测因素。这些发现强调了早期识别的重要性，并支持制定旨在改善这一高危人群预后的针对性管理策略。
