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Inflammatory response by 48 h after admission and mortality in patients with acute myocardial infarction complicated by cardiogenic shock.
- Source :
-
European heart journal. Acute cardiovascular care [Eur Heart J Acute Cardiovasc Care] 2023 May 04; Vol. 12 (5), pp. 306-314. - Publication Year :
- 2023
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Abstract
- Aims: Cardiogenic shock (CS) is known to induce an inflammatory response. The prognostic utility of this remains unclear. To investigate the association between C-reactive protein (CRP) levels and leucocyte count and mortality in patients with acute myocardial infarction complicated by CS (AMICS).<br />Methods and Results: Consecutive patients (N = 1716) admitted between 2010 and 2017 with an individually validated diagnosis of AMICS were included. The analysis was restricted to patients alive at 48 h after first medical contact and a valid CRP and leucocyte measurement at 48 ± 12 h from the first medical contact. A combined inflammatory score for each patient was computed by summing the CRP and leucocyte count z-scores to normalize the response on a standard deviation scale. Associations with mortality were analysed using a multivariable Cox proportional hazards model stratified by inflammatory response quartiles: Of the 1716 patients in the cohort, 1111 (64.7%) fulfilled inclusion criteria. The median CRP level at 48 h was 145 mg/dL [interquartile range (IQR) 96-211]. The median leucocyte count was 12.6 × 10-9/L (IQR 10.1-16.4). Patients with the highest inflammatory response (Q4) had lower median left ventricular ejection fractions and higher lactate levels at the time of diagnosis. The 30-day all-cause mortality rates were 46% in Q4 and 21% in Q1 (P < 0.001). In multivariable models, the inflammatory response remained associated with mortality [hazard ratio (HR)Q4 2.32, 95% confidence interval (CI) 1.59-3.39, P < 0.001]. The finding was also significant in AMICS patients presenting with out-of-hospital cardiac arrest following multivariable adjustment (HRQ4 3.37, 95% CI 2.02-4.64, P < 0.001).<br />Conclusion: Cardiogenic shock induces an acute inflammatory response, the severity of which is associated with mortality.<br />Competing Interests: Conflict of interest: None declared.<br /> (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Details
- Language :
- English
- ISSN :
- 2048-8734
- Volume :
- 12
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- European heart journal. Acute cardiovascular care
- Publication Type :
- Academic Journal
- Accession number :
- 36857166
- Full Text :
- https://doi.org/10.1093/ehjacc/zuad018