Predictive value of the baseline electrocardiogram ST-segment pattern in cardiogenic shock: Results from the CardShock Study

Tuija Javanainen, Heli Tolppanen, Johan Lassus, Markku S. Nieminen, Alessandro Sionis, Jindrich Spinar, José Silva-Cardoso, Matias Greve Lindholm, Marek Banaszewski, Veli Pekka Harjola, Raija Jurkko

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    Abstract

    © 2018 Wiley Periodicals, Inc. Background: The most common aetiology of cardiogenic shock (CS) is acute coronary syndrome (ACS), but even up to 20%–50% of CS is caused by other disorders. ST-segment deviations in the electrocardiogram (ECG) have been investigated in patients with ACS-related CS, but not in those with other CS aetiologies. We set out to explore the prevalence of different ST-segment patterns and their associations with the CS aetiology, clinical findings and 90-day mortality. Methods: We analysed the baseline ECG of 196 patients who were included in a multinational prospective study of CS. The patients were divided into 3 groups: (a) ST-segment elevation (STE). (b) ST-segment depression (STDEP). (c) No ST-segment deviation or ST-segment impossible to analyse (NSTD). A subgroup analysis of the ACS patients was conducted. Results: ST-segment deviations were present in 80% of the patients: 52% had STE and 29% had STDEP. STE was associated with the ACS aetiology, but one-fourth of the STDEP patients had aetiology other than ACS. The overall 90-day mortality was 41%: in STE 47%, STDEP 36% and NSTD 33%. In the multivariate mortality analysis, only STE predicted mortality (HR 1.74, CI 95 1.07–2.84). In the ACS subgroup, the patients were equally effectively revascularized, and no differences in the survival were noted between the study groups. Conclusion: ST-segment elevation is associated with the ACS aetiology and high mortality in the unselected CS population. If STE is not present, other aetiologies must be considered. When effectively revascularized, the prognosis is similar regardless of the ST-segment pattern in ACS-related CS.
    Original languageEnglish
    Article numbere12561
    JournalAnnals of Noninvasive Electrocardiology
    Volume23
    Issue number5
    DOIs
    Publication statusPublished - 1 Sep 2018

    Keywords

    • acute coronary syndrome
    • acute heart failure
    • cardiogenic shock
    • electrocardiography
    • prognosis

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    Javanainen, T., Tolppanen, H., Lassus, J., Nieminen, M. S., Sionis, A., Spinar, J., Silva-Cardoso, J., Greve Lindholm, M., Banaszewski, M., Harjola, V. P., & Jurkko, R. (2018). Predictive value of the baseline electrocardiogram ST-segment pattern in cardiogenic shock: Results from the CardShock Study. Annals of Noninvasive Electrocardiology, 23(5), [e12561]. https://doi.org/10.1111/anec.12561