Risk Factors And Short-term Survival With Different Hemodynamic Support Analysis Of STEMI Complicating Cardiogenic Shock

Objective:STEMI usually occurs sudden failure of cardiac pump function and leads to cardiogenic shock（CS）.Effective hemodynamics support is key to save life for patients with STEMI complicating with CS.This article aimed to explore relative factors of STEMI complicating CS and combine these relative factors to predict STEMI complicating CS.Furthermore,the relative factors of CS complicating short-term mortality and the short-term survival of among conservative therapy,intra-aortic ballon pump（IABP）and extracorporeal membrane oxygenation（ECMO）and relative factors of mortality with STEMI complicating CS were also explored.Methods:This study was a single-center and retrospective study.We collected the data of patients with STEMI who were hospitalized in cardiovascular department of Lanzhou University First Hospital from 1^st January 2019 to 31^st December 2020.All included patients were divided into two groups（CS and non-CS group）.Firstly,the baseline characteristics of two groups were compared to find statistical difference.Secondly,the baseline characteristics with statistical difference were putted into binary-Logistic regressive analysis find the ralative factors of STEMI complicating CS and the relative continuous variables were included in receiver operating characteristic（ROC）Curve.The area under cruve（AUC）were used to assess the sensitivity and specifity of relative continuous variables.Based on STEMI complicating CS with 30-day mortality or not,patients were divided into two subgroups（survival and non-survival group）.The Kaplan-Meier cruve was used to compare short-term survival among conservative therapy,IABP and ECMO groups.Log-rank test was used to compare the 30-day survival difference among three groups.After compared baseline characteristics of two subgroups,the baseline characteristics with statistical difference were putted into multivariate COX regression analysis to find independent protective or risk factors for STEMI complicating CS with short-term mortality.Results:Total of 728 patients were included in this study and divided to CS group（n=90）and non-CS group（n=628）.From binary-Logistic regression analysis,previous diabetes（OR=5.447,95%CI[2.089-14.205];p=0.001）,arterial blood lactate（OR=1.003,95%CI[1.001-1.006];p=0.010）,white blood cell（WBC）count（OR=1.003,95%CI[1.001-1.004];p<0.001）,serum creatinine（OR=1.002,95%CI[1.001-1.003],p<0.001）and culprit artery（LCX）（OR=3.289,95%CI[1.419-7.622];p=0.005）were independent risk factors for STEMI complicating CS.However,arterial blood p H（OR=0.996,95%CI[0.994-0.998],p=0.001）,post-PCI TIMI flow（OR=0.713,95%CI[0.538-0.946];p=0.019）,LVEF（OR=0.999,95%CI[0.998-0.999],p=0.031）and application of diuretic（OR=0.991,95%CI[0.983-0.998],p=0.016）were independent protective factors for STEMI complicating CS.After putting continuous variable（arterial blood lactate,serum creatinine,WBC count and arterial blood p H）into ROC curve analysis,combining arterial blood lactate and serum creatinine had highest predictive value for STEMI complicating CS（AUC=0.856,p<0.001 95%CI[0.814-0.898];sensitivity=77%,specificity=81,Youden index=0.57）.From univariate K-M survival analysis,the mortality was significantly higher in patients receiving ECMO than IABP（60.0%vs.19.4%;p=0.013）.Compared conservative treatment with IABP and ECMO,no statistical difference was found（28.3%vs.19.4%,p=0.383;28.3%vs.60.3%;p=0.081）.Comparing the baseline characteristics between two groups and putting all factors with statistical difference into multivariate COX regression analysis,arterial lactate(HR _adj.=1.275,95%CI[1.019-1.596];p=0.034),combining with f QRS(HR _adj.=3.544,95%CI[1.020-12.313];p=0.046)were independent risk factors for short-term mortality of STEMI complicating CS.Moreover,using（?）-blocker after admission(HR _adj.=0.234,95%CI[0.062-0.878];p=0.031),postoperative TIMI flow(HR _adj.=0.280,95%CI[0.147-0.534];p<0.001)and LVEF(HR _adj.=0.845,95%CI[0.745-0.957];p=0.008)were independent protective factors for mortality of STEMI complicating CS.In the multivariate COX regression analysis,different hemodynamic support measures were not related with short-term mortality of STEMI complicating CS（HR adj.=0.507,95%CI[0.229-2.073];p=0.507）.Conclusion:1.Previous diabetes,first elevated arterial blood lacate and serum creatinine and culprit vessel（LCX）were independent risk factors of STEMI complicating CS;High-level arterial p H,post-PCI TIMI flow and LVEF and application of diuretic were independent protective factors of STEMI complicating CS.2.Combining arterial blood lacate and serum creatinine could better predict STEMI complicating CS and based on this prediction,we could early intervene for patients to reduce the risk of mortality;3.Application ofβ-blocker,as a independent protective risk for short-term mortality of STEMI complicating CS,might be a novel intervention for patients to improve short-term mortality.4.Application of difference mechanical circulartory support for STEMI complicating with CS was not related with short-term mortality.MCSD might provide a more stable status of hemodynamic to useβ-blocker.It needed,however,further trials to verify.