Clinical characteristics, management, and outcomes of acute myocardial infarction-related cardiogenic shock patients with and without out-of-hospital cardiac arrest: a Gulf region registry analysis

Abstract

Background

Out-of-hospital cardiac arrest (OHCA) in the setting of acute myocardial infarction-related cardiogenic shock (AMI-CS) represents a particularly high-risk subgroup. The Cardiac Arrest Hospital Prognosis (CAHP) score is a prognostic tool used in post-arrest care; however, its utility in predicting in-hospital mortality among OHCA survivors with AMI-CS in the Gulf region remains unclear. This study assessed differences in clinical characteristics and outcomes between AMI-CS patients with and without OHCA and evaluated the discriminative ability of the CAHP score.

Methods

A retrospective analysis was performed using data from the Gulf-CS registry, including 1513 patients diagnosed with AMI-CS from 2020 to 2022. Patients were stratified by the presence of OHCA at presentation.

Results

Among the cohort, 138 patients (9.1 %) experienced OHCA and survived to hospital presentation. These patients were younger and with fewer comorbidities. ST-elevation myocardial infarction (STEMI) was significantly more common in the OHCA group (89.1 % vs. 72.3 %, P < 0.001). Despite the severity of OHCA, in-hospital mortality was lower in this group compared to those without arrest (34.8 % vs. 46.5 %, P = 0.009), although they had a higher incidence of cerebrovascular accidents (9.4 % vs. 5.2 %, P = 0.042). The CAHP score was strongly associated with in-hospital mortality (OR: 1.067, P < 0.001), with the highest risk observed in those with scores >200 (64.6 % mortality).

Conclusion

Among AMI-CS patients, those with OHCA who survive to hospital presentation exhibit lower in-hospital mortality. The CAHP score demonstrated good discriminative ability for in-hospital mortality in this population.