Arabi Abdulrahman, Al Suwaidi Jassim, Daoulah Amin, AlQahtani Awad Abdulrazaq, Shahid Zubair, Jamjoom Ahmed, Elmahrouk Ahmed, AlShehri Mohammed, Panduranga Prashanth, Al Rawahi Abeer Said Mohamed, Livingston Gladsy Selva, Mousa Ala'a Al-Deen Tayseer, Aloui Hatem, Aldossari Mubarak, Yousif Nooraldaem, Noor Husam, Rajan Rajesh, Al Mahmeed Wael, Khan Hassan, Qutub Mohammed, Arafat Amr A, Kanbr Omar, Almarghany Alsayed, Kahin Mokhtar, Abohasan Abdulwali, Al Nasser Faisal, Alzahrani Badr, Aldossari Alaa, Hassan Taher, Alenezi Abdullah, Alharbi Waleed, Balghith Mohammed Ali, Alobaikan Sultan, Alshali Khalid, Lotfi Amir
Hamad Medical Corporation, Doha, Qatar
Hamad Medical Corporation, Doha, Qatar.
BMJ Open. 2025 Jun 4;15(6):e099208. doi: 10.1136/bmjopen-2025-099208.
To evaluate the association between the timing of invasive mechanical ventilation (MV) initiation and clinical outcomes in patients with cardiogenic shock (CS) secondary to ST-elevation myocardial infarction (STEMI).
Retrospective analysis of a multicentre registry.
Data were obtained from the Gulf-Cardiogenic Shock registry, which includes hospitals across six countries in the Middle East.
1117 patients diagnosed with STEMI and CS. Of these, 672 (60%) required MV and were included in this analysis.
The primary outcome was in-hospital mortality. Secondary outcomes included comparisons of baseline characteristics, Society of Coronary Angiogram and Intervention (SCAI) shock stage, and clinical parameters among groups based on time to MV.
Participants were categorised by time from shock diagnosis to MV: early (≤15 min), intermediate (30 min) and late (≥60 min). Median times were 15 min (IQR 10-20), 30 min (IQR 25-35) and 60 min (IQR 45-70), respectively. Baseline characteristics were comparable across groups. Increased delay in MV was associated with a higher mortality risk during the first 60 min post-diagnosis, beyond which the risk plateaued. Delayed MV was an independent predictor of in-hospital mortality (OR 2.14, 95% CI 1.36 to 3.38, p<0.001).
Early initiation of MV in patients with STEMI complicated by CS was associated with lower in-hospital mortality. These findings highlight the importance of timely respiratory support, warranting further investigation in prospective or randomised controlled studies.
评估因ST段抬高型心肌梗死（STEMI）继发心源性休克（CS）患者开始有创机械通气（MV）的时机与临床结局之间的关联。
对多中心注册研究进行回顾性分析。
数据来自海湾心源性休克注册研究，该研究涵盖中东六个国家的医院。
1117例诊断为STEMI和CS的患者。其中，672例（60%）需要MV并纳入本分析。
主要结局为住院死亡率。次要结局包括根据MV时间分组比较基线特征、冠状动脉造影和介入学会（SCAI）休克分期以及临床参数。
参与者根据从休克诊断到MV的时间进行分类：早期（≤15分钟）、中期（30分钟）和晚期（≥60分钟）。中位时间分别为15分钟（IQR 10 - 20）、30分钟（IQR 25 - 35）和60分钟（IQR 45 - 70）。各组基线特征具有可比性。MV延迟增加与诊断后最初60分钟内较高的死亡风险相关，超过该时间风险趋于平稳。延迟MV是住院死亡率的独立预测因素（OR 2.14，95%CI 1.36至3.38，p<0.001）。
STEMI合并CS患者早期开始MV与较低的住院死亡率相关。这些发现凸显了及时呼吸支持的重要性，值得在前瞻性或随机对照研究中进一步探究。
