Impact of cardiac arrest in patients with cardiogenic shock due to ST-elevation myocardial infarction

Franco, Danilo (author), Bělohlávek, Jan (author), Rob, Daniel (author), Kovarnik, Tomas (author), Goslar, Tomaž (author), Fister, Miša (author), Radšel, Peter (author), Izzo, Raffaele (author), Di Gioia, Giuseppe (author), Esposito, Giovanni (author), Noč, Marko (author)

Background: Cardiogenic shock (CS) frequently complicates ST-elevation myocardial infarction (STEMI) and may be associated with cardiac arrest occurring either as out-of-hospital (OHCA) or in-hospital cardiac arrest (IHCA). Aim: To compare clinical characteristics, coronary anatomy, management and survival among patients with CS without cardiac arrest (STEMI-CS-no CA), CS with OHCA (STEMI-CS-OHCA) and CS with IHCA (STEMI-CS-IHCA). Methods: We conducted a retrospective study including consecutive patients with CS and STEMI undergoing immediate coronary angiography and percutaneous coronary intervention (PCI) who were admitted to two tertiary university hospitals between 2016 and 2025. Results: Among 345 patients, 150 (43.5%) had STEMI-CS-no CA, 120 (34.8%) STEMI-CS-OHCA, and 75 (21.7%) STEMI-CS-IHCA. STEMI-CS-IHCA patients were older, less frequently presented with an initial shockable rhythm (36.0% vs 61.0%, p = 0.002) and had shorter time to return of spontaneous circulation (10.0 vs 19.6 min, p < 0.001) compared to STEMI-CS-OHCA. They had also lower arterial pressure, left ventricular ejection fraction, estimated glomerular filtration rate and higher arterial lactate compared to STEMI-CS-no CA and STEMI-CS-OHCA. Coronary complexity increased progressively with SYNTAX score rising from 18.6 in STEMI-CS-no CA to 21.5 in STEMI-CS-OHCA and to 27.2 in STEMI-CS-IHCA (p < 0.001). At 1-year, all-cause mortality was 67.3% in STEMI-CS-no CA, 78.3% in STEMI-CS-OHCA (p = 0.004) and 82.7% in STEMI-CS-IHCA (p < 0.001) without significant difference between cardiac arrest subgroups (p = 0.555). Conclusion: In STEMI-related CS, concomitant OHCA or IHCA is associated with distinct clinical profiles, coronary anatomy, intensity of treatment and markedly impaired long-term survival.

• Language: English
• Keywords: cardiac arrest, cardiogenic shock, ischemia, PCI, prognosis, STEMI, ST-elevation myocardial infarction
• Work type: Article
• Typology: 1.01 - Original Scientific Article
• Organization: MF - Faculty of Medicine
• Publication status: Published
• Publication version: Version of Record
• Year: 2026
• Number of pages: 7 str.
• Numbering: Vol. 224, art. 111094
• PID: 20.500.12556/RUL-183986
• UDC: 616-083.98
• ISSN on article: 1873-1570
• DOI: 10.1016/j.resuscitation.2026.111094
• COBISS.SI-ID: 277745411
• Publication date in RUL: 23.06.2026

Record is a part of a journal

• Title: Resuscitation
• Publisher: Elsevier
• ISSN: 1873-1570
• COBISS.SI-ID: 23109893

Licences

• License: CC BY 4.0, Creative Commons Attribution 4.0 International
• Link: http://creativecommons.org/licenses/by/4.0/
• Description: This is the standard Creative Commons license that gives others maximum freedom to do what they want with the work as long as they credit the author.

Secondary language

• Language: Slovenian
• Keywords: srčni zastoj, kardiogeni šok, ishemija, perkutana koronarna intervencija (PCI), prognoza, akutni miokardni infarkt z dvigom veznice ST (STEMI)

Projects

• Funder: Federico II University of Naples
• Funding programme: PhD programme
• Acronym: CardioPaTh