Right ventricular dysfunction as a mortality determinant for patients with cardiogenic shock induced by acute myocardial infarction
Author Department
Cardiology; Medicine
Document Type
Article, Peer-reviewed
Publication Date
3-2025
Abstract
Background: Cardiogenic shock (CS) secondary to acute myocardial infarction (AMI) is a major cause of in-hospital mortality. With the addition of right ventricular dysfunction (RVD), it is associated with poorer outcomes. This study examines the impact of RVD on mortality in CS-AMI patients, highlighting the importance of early RVD identification and tailored management.
Methods: Data from the Gulf Cardiogenic Shock (Gulf-CS) registry-a multicenter registry of CS-AMI patients from six Gulf countries-were analyzed to compare in-hospital and long-term outcomes for patients with and without RVD. RVD was defined by echocardiographic criteria: TAPSE <17 mm, S' wave <12 cm/s, and TAPSE/PASP ratio < 0.34. Multivariable logistic and Cox regression models were used to identify in-hospital and follow-up mortality predictors.
Results: Among 1,513 CS-AMI patients, RVD was independently associated with higher in-hospital mortality (55.87% vs. 42.89%, p < 0.001) and lower survival at 6, 12, 18, and 24 months (58%, 35%, 18%, and 6% vs. 73%, 53%, 38%, and 30%; p < 0.001). Predictors of in-hospital mortality included advanced SCAI shock stage, cardiac arrest, age, NSTEMI, number of vessels affected, and elevated creatinine, while follow-up mortality was associated with advanced SCAI stage, reduced LVEF, elevated BUN, history of CABG and comorbidities including COPD and prior CVA.
Conclusion: RVD is a significant independent predictor of both in-hospital and long-term mortality in CS-AMI, highlighting the need for early RVD assessment and specific interventions. This study's findings support the integration of RV-focused management strategies to improve survival outcomes in this high-risk population.
Recommended Citation
Daoulah A, Seraj S, Elmahrouk A, Yousif N, Panduranga P, Almahmeed W, Arabi A, Alshehri M, Aloui HM, Arafat AA, Qutub MA, Alharbi W, Rajan R, Kahin MA, Alenezi A, Al Maashani S, Hassan T, Alswuaidi J, Alqahtani A, Aldossari MA, Al Jarallah M, Alshehri A, Elganady A, Alzahrani B, Alqahtani AM, Al Nasser FOM, Amin H, Alama MN, Aldossari A, Al Obaikan S, Almarghany AA, Kanbr O, Jamjoom A, Elmahrouk Y, Abdulhabeeb IAM, Balghith M, Hersi AS, Al Rawahi ASM, Alkholy MAEA, Hussien AF, Almoghairi A, Alama MMA, Ghani MA, Alhussini AU, Basardah A, Alshehri B, AlObaid L, Sasti SS, Abualnaja S, Chachar TS, Khan H, Hashmani S, Ghonim AA, Almerri K, Alsofayan RW, Shawky AM, Lotfi A. Right ventricular dysfunction as a mortality determinant for patients with cardiogenic shock induced by acute myocardial infarction. Shock. 2025 Mar 3. doi: 10.1097/SHK.0000000000002583. Epub ahead of print.
PMID
40101947
