Abstract 12524: Very Long-term Mortality after St Elevation Myocardial Infarction (stemi) Complicated by Cardiogenic Shock

Introduction: About 5-10% of myocardial infarctions develop severe form of presentation, with cardiogenic shock (CS). Despite evidence showing higher in-hospital and short-term mortality in patients with STEMI complicated by CS, long-term follow-up data is lacking. Hypothesis: The aim of this study was to assess very long-term prognosis of survived patients with STEMI complicated by CS. Methods: STEMI patients (n=1,444) were included (1998-2017) and followed for up to 17.6 years (median 5.4 [2.5-9.9] years). Long-term survival was assessed by Log-Rank test. Results: Compared to STEMI without CS, patients who presented CS (n=118) had no significant differences regarding age (62.0 ± 11.8 vs. 60.7 ± 12.7; p=0.31) and female sex (28.0% vs. 25.1%, p=0.51), but had lower left ventricle ejection fraction (38.8±13.0% vs. 49.7±13.1%, p<0.001) and higher mean baseline creatinine levels (1.4±0.6mg/dL vs. 1.2±0.7mg/dL, p=0.002). Of note, CS patients presented higher in-hospital mortality (42.2%) compared to those without CS (OR=28.5; 18.1-44.7, p<0.001). Long-term survival was lower in patients with CS (10.7±0.6 vs. 13.3±0.2 years, log rank =0.016). By multivariate analysis adjusted for baseline characteristics the main factors predicting mortality were age (HR=1.06; CI95% 1.05-1.07, p<0.001), previous MI (HR=1.34;CI% 1.06-1.69, p=0.01), history of heart failure (HR=1.65; CI95% 1.15-2.37, p=0.007), stroke (HR=1.67; CI95% 1.12-2.47, p=0.01), diabetes (HR=1.41; CI95% 1.14-1.74, p=0.001) and the presence of CS (HR=3.65; CI95% 2.92-4.56, p<0.001). Conclusions: In a very long-term follow-up after a STEMI, CS increased ~4-fold the mortality rates. After hospital discharge, CS remains an important independent risk factor for death in the follow-up. Our findings reinforce the importance of intensive clinical monitoring with optimal medical and non-pharmacological therapy for the remarkable risk factors in the very long-term post-STEMI complicated by CS.