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Category: Volume 11 Issue 09 September 2023
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Title: A study on the effect of biochemical parameters on the outcome and risk stratification of patients with cardiogenic shock following acute myocardial infarction in a Tertiary Care Hospital in South India

Authors: Dr Poornima Nair, Dr Sivakumar K.

 DOI: https://dx.doi.org/10.18535/jmscr/v11i9.13

Abstract

Introduction: Cardiogenic shock (CS) is the most extreme complication of myocardial infarction and it is the initial presentation of at least 1 in 15 patients admitted to ICCU. Despite heroic efforts, the in-hospital mortality due to CS is still very high.

Aims

  1. To determine the prognosis of patients admitted with cardiogenic shock as a complication of acute MI
  2. To stratify the risk in the above patients with respect to the levels of admission day random blood glucose, thyroid hormone levels- T3,T4,TSH, Lipid profile- Total cholesterol, triglycerides, HDL,LDL, serum uric acid, blood urea and serum creatinine.

Methodology: We conducted a prospective, observational, descriptive, intention to treat study of patients presenting with cardiogenic shock as a result of acute MI presenting to the ICCU of Government Medical College, Coimbatore. The outcome and the multiple variables (hematological and biochemical parameters) were studied so as to stratify the risk of poor prognosis.

Results & Discussion: Out of the 200 cases of cardiogenic shock included in the study, 170 cases survived and 30 patients died attributing to 15%. The mean age in the death group was 53.13 years and in the survival group was 59.7 years. Most patients presented within a window period of 6-12 hrs. Admission blood pressure <40 mmhg was associated with early mortality despite use of vasopressor agents. EF <40% was associated with early death. Thrombolytic therapy didn’t show to improve the outcome of cardiogenic shock. Age,  smoking, past history of hypertension, window period, admission blood pressure < 60 mmHg , anterior wall STEMI were found to be statistically significant determinants of death. An RBS >200 mg/dl, urea >40 mg/dl, creatinine >2 mg/dl, TC >200 mg/dl, TG >150 mg/dl, HDL <40 mg/dl predicts MACE in acute MI patients. The admission time blood pressure, uric acid and urea were independently associated with bad outcomes in cardiogenic shock.

Conclusion: The prognosis of cardiogenic shock is poor despite effective early intervention methods. Early identification of risk factors can prompt prevention of MACE and hence help early treatment initiation to avoid bad prognosis in CS.

Keywords: Myocardial Infarction, ST elevation Myocardial Infarction, Shock, Coronary artery disease.

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Corresponding Author

Dr Poornima Nair

The Tamilnadu Dr MGR Medical University, Kerala University of Health Science