Predictive role of basic biochemical markers in mortality risk for cardiogenic shock complicating acute myocardial infarction

Cardiogenic shock (CS) complicates 3-13% of acute myocardial infarction (AMI) cases and carries a mortality rate of roughly 40% within the first 30 days and 50% within the first year, making it the leading cause of death among AMI patients. Furthermore, AMI is responsible for 81% of CS cases. The pathophysiological mechanisms activated during CS contribute to alterations in several biochemical parameters, which may serve as crucial indicators in identifying high-risk patients who develop CS.

This study aimed to identify basic biochemical laboratory predictors of mortality in patients who develop CS following AMI.

We conducted a prospective cross-sectional study from March 20 to October 20, 2024. Patients admitted with acute coronary syndrome (STEMI or NSTEMI) were monitored, and those who developed CS were included. Patients were then categorized into two groups based on outcomes: those who did not survive (first group) and those who survived (second group).

Out of 1,166 patients admitted for acute coronary syndrome at our Cardiology Clinic over the seven-month study period, 86 (7.4%) developed CS, with 44 patients (51%) succumbing to the condition. Table 1 compares the basic laboratory parameters between the two groups. The mortality group had significantly lower hematocrit and pH levels, and higher creatinine, blood glucose, and potassium levels (though potassium remained within the reference range). Parameters showing statistical significance were included in a multiple regression model, which demonstrated an explanatory power of approximately 40% (R² = 0.39) and statistical significance (p < 0.0001), as shown in Table 2a. This indicates that combined levels of hematocrit, potassium, pH, creatinine, and glucose can predict mortality in around 40% of patients with acute coronary syndrome and CS. Among these, pH and potassium levels were identified as independent predictors of mortality in CS (Table 2b).

In our center, approximately 7% of patients with acute coronary syndrome develop CS, with nearly half resulting in death. Lower pH and hematocrit levels, along with elevated creatinine, blood glucose, and potassium levels, suggest an increased risk of mortality in CS patients, with pH and potassium identified as independent predictors of fatal outcomes.