Prognostic impact of no ST segment elevation resolution in acute myocardial infarction complicated by cardiogenic shock

Background : ST segment resolution (RST), during fibrinolysis therapy (FT) for acute myocardial infarction (AMI), is a good marker of myocardial reperfusion. The in-hospital mortality increases with time to reperfusion when cardiogenic shock (CS) complicates AMI. Objectives: The aim of this study is to assess the no-RST during prehospital fibrinolysis for ST segment elevation myocardial infarction (STEMI) complicated by CS as an early predictor of mortality for triage. Method : In a cohort of 643 patients, receiving prehospital FT for STEMI (pain to FT, mean time 120mn), 39 patients had STEMI complicated by CS. ECG was performed prior starting the FT, baseline ECG, and on ICU admission, admission ECG (FT to ICU, mean time 55mn).Two classes of RST were defined : no resolution (RST 30%).ICU mortality was investigated for each class of RST within 30 days. Results : Results are shown in the table below. No-RST on admission ECG is significantly (p<0.05) correlated to a higher ICU mortality rate when STEMI is complicated by CS. Conclusion : No-RST, during the first hour of FT for STEMI complicated by CS, predicts no myocardial reperfusion and high risk of ICU death within 30 days. This clinical marker is easy to perform at bedside, and should participate to an early scoring system for decision making. STEMI patients CS patients STEMI mortality(%) CS mortality (%)