Timing of mechanical ventilation and its association with in-hospital outcomes in patients with cardiogenic shock following ST-elevation myocardial infarction: a multicentre observational study
Author Department
Cardiology; Medicine
Document Type
Article, Peer-reviewed
Publication Date
6-2025
Abstract
Objective: 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).
Design: Retrospective analysis of a multicentre registry.
Setting: Data were obtained from the Gulf-Cardiogenic Shock registry, which includes hospitals across six countries in the Middle East.
Participants: 1117 patients diagnosed with STEMI and CS. Of these, 672 (60%) required MV and were included in this analysis.
Primary and secondary outcome measures: 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.
Results: 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).
Conclusions: 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.
Keywords: Coronary intervention; Ischaemic heart disease; Mortality; Myocardial infarction; Ventilators, Mechanical.
Recommended Citation
Arabi A, Al Suwaidi J, Daoulah A, AlQahtani AA, Shahid Z, Jamjoom A, Elmahrouk A, AlShehri M, Panduranga P, Al Rawahi ASM, Livingston GS, Mousa AAT, Aloui H, Aldossari M, Yousif N, Noor H, Rajan R, Al Mahmeed W, Khan H, Qutub M, Arafat AA, Kanbr O, Almarghany A, Kahin M, Abohasan A, Al Nasser F, Alzahrani B, Aldossari A, Hassan T, Alenezi A, Alharbi W, Balghith MA, Alobaikan S, Alshali K, Lotfi A. Timing of mechanical ventilation and its association with in-hospital outcomes in patients with cardiogenic shock following ST-elevation myocardial infarction: a multicentre observational study. BMJ Open. 2025 Jun 4;15(6):e099208. doi: 10.1136/bmjopen-2025-099208.
PMID
40467313