Characteristics and clinical predictors of cardiogenic shock among patients presenting with acute ST-segment elevation myocardial infarction

Abstract

Background: Cardiogenic shock (CS) is the leading cause of mortality in ST-segment elevation myocardial infarction (STEMI). Patients with acute coronary syndrome in Saudi Arabia present a decade younger than Western cohorts and have a higher diabetes burden, yet contemporary local data on CS are limited. We aimed to determine the incidence, characteristics, and predictors of CS in a Saudi STEMI cohort.Methods: Single-center retrospective cohort study of consecutive adult patients with acute STEMI admitted to King Abdulaziz Cardiac Center, Riyadh, from January 2019 to December 2024. CS was defined by the SHOCK trial criteria. Univariate and multivariate logistic regression identified independent predictors.Results: A total of 878 patients were included (mean age 57.2 ± 13.6 years; 86.6% male); 80 (9.1%) developed CS. Compared with patients without CS, those with CS had a higher prevalence of dyslipidemia (58.8% vs. 44.6%, p = 0.016) and ventricular arrhythmia (17.5% vs. 5.5%, p < 0.001), higher peak troponin and N-terminal pro-B-type natriuretic peptid, and lower hemoglobin, sodium, potassium, and estimated glomerular filtration rate. No differences were observed in age, sex, hypertension, diabetes, or infarct location. In multivariate analysis, independent predictors of CS were female sex odds ratio (OR 0.18, 95% confidence intervals 0.06-0.52), dyslipidemia (OR 2.39, 1.22-4.70), arrhythmia (OR 3.69, 1.63-8.37), peak troponin (p = 0.040), peak blood urea nitrogen (OR 1.05, 1.01-1.08), nadir hemoglobin (OR 0.97, 0.96-0.99), and nadir potassium (OR 0.16, 0.07-0.34).Conclusion: CS occurred in 9.1% of this contemporary Saudi STEMI cohort. The predictors that emerged were not the classical Western ones; larger multicenter studies should confirm these findings and inform regional risk stratification.