Introduction
Methods
Study population
Study protocol
Follow up
Statistical analysis
Result
Characteristics of study cohort
Non-CS (n = 562) | CS on admission (n = 32) | Developed CS (n = 81) | p-value | |
---|---|---|---|---|
Age (years), mean ± SD | 64 ± 12.7 | 66 ± 11.7 | 64 ± 12.7 | 0.593 |
Male sex, n (%) | 444 (79) | 25 (78) | 64 (79) | 0.993 |
Hypertension, n (%) | 359 (64) | 16 (50) | 44 (54) | 0.089 |
Diabetes, n (%) | 142 (25) | 14 (44) | 13 (16) | 0.009#, && |
Smoking, n (%) | 315 (56) | 17 (53) | 46 (57) | 0.938 |
Prior stroke, n (%) | 76 (14) | 7 (22) | 10 (12) | 0.383 |
Hyperlipidaemia, n (%) | 44 (8) | 5 (16) | 5 (6) | 0.233 |
Multivessel lesions, n (%) | 140 (25) | 13 (41) | 32 (40) | 0.005#, ** |
Known kidney dysfunction, n (%) | 67 (12) | 8 (25) | 12 (15) | 0.086 |
Prior MI, n (%) | 15 (3) | 3 (9) | 2 (2) | 0.09 |
Pre-procedural SBP (mmHg), mean ± SD | 125 ± 18.9 | 80 ± 6.6 | 112 ± 20.6 | < 0.001###, ***, &&& |
Pre-procedural HR (bpm), mean ± SD | 79 ± 14.7 | 114 ± 18.5 | 87 ± 16.5 | < 0.001###, ***, &&& |
Shock index, mean ± SD | 0.65 ± 0.16 | 0.96 ± 0.22 | 0.81 ± 0.25 | < 0.001###, ***, &&& |
LVEF(%), mean ± SD | 45 ± 5.6 | 44.6.4 | 45 ± 6.6 | 0.319 |
Creatinine (mmol/L), mean ± SD | 70(24) | 76 (39) | 71 (24) | 0.409 |
TG (mmol/L), mean ± SD | 1.66 ± 1.09 | 1.39 + ±0.73 | 1.61 ± 0.88 | 0.377 |
TCh (mmol/L), mean ± SD | 4.29 ± 1.02 | 4.27 ± 1.19 | 4.27 ± 0.97 | 0.985 |
LDL-C (mmol/L), mean ± SD | 2.38 ± 0.74 | 2.46 ± 0.84 | 2.41 ± 0.70 | 0.792 |
HDL-C (mmol/L), mean ± SD | 1.00 ± 0.38 | 1.00 ± 0.28 | 0.95 ± 0.34 | 0.525 |
Symptom-wire interval (min),median (IQR) | 240 (328) | 168(202) | 237 (242) | 0.067 |
IABP utility, n (%) | 15 (3) | 8 (25) | 21 (26) | < 0.001###, *** |
Anterior MI, n (%) | 275 (49) | 10 (31) | 29 (36) | 0.018#,* |
Killips classification | < 0.001###,*,&&& | |||
I, n (%) | 463 (82) | 0 | 62 (77) | |
II, n (%) | 88 (16) | 0 | 13 (16) | |
III, n (%) | 12 (2) | 0 | 6 (7) | |
V, n (%) | 0 | 32 (100) | 0 | |
Post-procedure TIMI flow | 0.079 | |||
3, n (%) | 557 (99) | 31 (97) | 78 (96) | |
2, n (%) | 4 (1) | 0 (0) | 3 (4) | |
1, n (%) | 1 (0) | 1 (3) | 0 (0) | |
IRA | < 0.001##, * | |||
LM/LM-LAD, n (%) | 286 (51) | 10 (31) | 29 (36) | |
LCX/OM, n (%) | 90 (16) | 2 (6) | 11 (13) | |
RCA/PDA/PL, n (%) | 186 (33) | 20 (63) | 41 (51) | |
Medicine | ||||
β blocker, n (%) | 483 (86) | 21 (67) | 63 (78) | 0.177 |
ACEI/ARB, n (%) | 427 (76) | 21 (67) | 54 (67) | 0.517 |
Aldactone, n (%) | 90 (16) | 11 (33) | 15 (18) | 0.427 |
Endpoints follow-up
Events | Non-CS (n = 562) | CS on admission (n = 32) | Developed CS (n = 81) | p-value |
---|---|---|---|---|
All cause death, n (%) | 13(2) | 1(3) | 2(2) | 0.956 |
MACE | ||||
Cardiac death, n (%) | 13(2) | 1(3) | 2(2) | 0.956 |
Angina/Recurrent MI, n (%) | 4(1) | 0(0) | 0(0) | 0.667 |
Worsening of cardiac function, n (%) | 2(0) | 1(3) | 1(1) | 0.101 |
Non-fatal stroke, n (%) | 0(0) | 1(3) | 0(0) | P < 0.001 |
Univariate | Multivariable | |||||
---|---|---|---|---|---|---|
HR | 95% CI | p-value | HR | 95% CI | p-value | |
Age | 1.094 | 1.070–1.119 | < 0.001 | 1.071 | 1.045–1.099 | < 0.001 |
Male sex | 3.383 | 2.167–5.282 | < 0.001 | 2.105 | 1.292–3.431 | 0.003 |
Hypertension | 1.13 | 0.709–1.802 | 0.608 | – | – | – |
Diabetes | 1.193 | 0.733–1.941 | 0.478 | – | – | – |
Smoking | 0.753 | 0.353–1.165 | 0.135 | – | – | – |
Prior Stroke | 3.749 | 2.348–5.985 | < 0.001 | 2.209 | 1.347–3.621 | 0.002 |
Hyperlipdemia | 0.279 | 0.069–1.137 | 0.075 | – | – | – |
Known kidney dysfunction | 1.663 | 1.042–2.652 | 0.033 | – | – | – |
Prior MI | 2.138 | 0.780–5.865 | 0.14 | – | – | – |
Pre-procedural SBP | 0.988 | 0.977–0.998 | 0.023 | – | – | – |
Pre-procedural HR | 1.021 | 1.009–1.033 | 0.001 | – | – | – |
LVEF, per % increased | 0.9 | 0.868–0.933 | < 0.001 | 0.931 | 0.893–0.967 | < 0.001 |
TG, per mmol/L increased | 0.72 | 0.565–1.003 | 0.056 | – | – | – |
TCh, per mmol/L increased | 0.965 | 0.769–1.209 | 0.755 | – | – | – |
LDL-C, per mmol/L increased | 0.872 | 0.634–1.199 | 0.4 | – | – | – |
HDL-C, per mmol/L increased | 1.61 | 0.712–2.553 | 0.079 | – | – | – |
Multivessel lesions | 1.778 | 1.148–2.754 | 0.01 | – | – | – |
Time of symptom-wire, per hour increased | 1.016 | 1.008–1.024 | < 0.001 | – | – | – |
IABP utility | 1.449 | 0.697–3.014 | 0.32 | – | – | – |
Shock index (per 0.1 increased) | 1.152 | 1.078–1.230 | < 0.001 | – | – | – |
Anterior MI | 0.726 | 0.465–1.132 | 0.158 | – | – | – |
Onset stage of CS | ||||||
Non- CS (reference) | 1 | – | – | – | – | – |
CS on admission | 3.412 | 1.619–7.191 | 0.001 | – | – | – |
developed CS | 1.692 | 0.954–2.999 | 0.072 | – | – | – |
Killips Classification | ||||||
Killips = 1(reference) | 1 | – | – | – | – | – |
Killips = 2 | 2.405 | 1.426–4.055 | 0.001 | – | – | – |
Killips = 3 | 3.774 | 1.493–9.538 | 0.005 | – | – | – |
Killips = 4 | 4.566 | 2.131–7.782 | < 0.001 | – | – | – |
post-PCI TIMI flow of IRA | ||||||
3(reference) | 1 | – | – | – | – | – |
2 | 1.651 | 0.229–11.898 | 0.619 | – | – | – |
1 | 4.762 | 0.658–34.465 | 0.122 | – | – | – |
Univariate | Multivariate | |||||
---|---|---|---|---|---|---|
HR | 95% CI | p-value | HR | 95% CI | p-value | |
Age | 1.066 | 1.041–1.091 | < 0.001 | 1.068 | 1.038–1.099 | < 0.001 |
Male sex | 3.543 | 2.132–5.889 | < 0.001 | 2.100 | 1.196–3.688 | 0.01 |
Hypertension | 1.968 | 1.082–3.582 | 0.027 | – | – | – |
Diabetes | 1.429 | 0.835–2.444 | 0.193 | – | – | – |
Smoking | 0.684 | 0.288–1.011 | 0.099 | – | – | – |
Prior Stroke | 1.865 | 1.007–3.453 | 0.047 | 1.989 | 1.124–3.523 | 0.018 |
Hyperlipdemia | 0.177 | 0.024–1.276 | 0.086 | – | – | – |
Known kidney dysfunction | 1.764 | 1.035–3.007 | 0.037 | – | – | – |
Prior MI | 1.345 | 0.328–5.519 | 0.681 | – | – | – |
Pre-procedural SBP | 0.992 | 0.975–1.001 | 0.081 | – | – | – |
Pre-procedural HR | 1.019 | 1.003–1.035 | 0.017 | – | – | – |
LVEF, per % increased | 0.949 | 0.909–0.991 | 0.017 | 0.911 | 0.871–0.954 | < 0.001 |
TG, per mmol/L increased | 0.889 | 0.679–1.165 | 0.394 | – | – | – |
TCh, per mmol/L increased | 0.811 | 0.623–1.055 | 0.118 | – | – | – |
LDL-C, per mmol/L increased | 0.74 | 0.518–1.057 | 0.098 | |||
HDL-C, per mmol/L increased | 1.075 | 0.572–2.020 | 0.823 | – | – | – |
Multivessel lesions | 1.954 | 1.191–3.208 | 0.008 | – | – | – |
Time of symptom-wire, per hour increased | 1.011 | 0.999–1.023 | 0.081 | – | – | – |
IABP utility | 2.004 | 0.951–4.224 | 0.068 | – | – | – |
Shock index (per 0.1 increased) | 1.2 | 1.079–1.334 | 0.001 | – | – | – |
Anterior MI | 0.795 | 0.479–1.319 | 0.374 | – | – | – |
Onset stage of CS | ||||||
Non- CS (reference) | 1 | – | – | 1 | – | – |
CS on admission | 3.345 | 1.496–7.479 | 0.003 | 2.739 | 1.210–6.204 | 0.016 |
developed CS | 2.346 | 1.252–4.395 | 0.008 | 2.233 | 1.164–4.286 | 0.016 |
Killips Classification | ||||||
Killips = 1(reference) | 1 | – | – | – | – | – |
Killips = 2 | 2.737 | 1.502–4.988 | 0.001 | – | – | – |
Killips = 3 | 3.84 | 1.694–8.700 | 0.007 | – | – | – |
Killips = 4 | 4.13 | 1.460–11.681 | 0.001 | – | – | – |
post-PCI TIMI flow of IRA | ||||||
3(reference) | 1 | – | – | – | – | – |
2 | 4.403 | 1.071–18.098 | 0.04 | – | – | – |
1 | 6.488 | 1.191–27.228 | 0.035 | – | – | – |
Univariate | Multivariate | |||||
---|---|---|---|---|---|---|
HR | 95% CI | p-value | HR | 95% CI | p-value | |
Age | 1.028 | 1.016–1.040 | < 0.001 | 1.017 | 1.005–1.031 | 0.005 |
Male sex | 1.413 | 1.010–1.882 | 0.043 | – | – | – |
Hypertension | 1.009 | 0.760–1.340 | 0.95 | – | – | – |
Diabetes | 1.23 | 0.912–1.660 | 0.175 | – | – | – |
Smoking | 0.812 | 0.617–1.068 | 0.136 | – | – | – |
Prior Stroke | 1.863 | 1.338–2.594 | < 0.001 | 1.639 | 1.146–2.344 | 0.007 |
Hyperlipdemia | 0.909 | 0.545–1.514 | 0.713 | – | – | – |
Known kidney dysfunction | 0.827 | 0.589–1.162 | 0.274 | – | – | – |
Prior MI | 1.549 | 0.763–3.145 | 0.226 | – | – | – |
Pre-procedural SBP | 0.996 | 0.990–1.002 | 0.213 | – | – | – |
Pre-procedural HR | 1.005 | 0.997–1.013 | 0.192 | – | – | – |
LVEF, per % increased | 0.962 | 0.940–0.984 | 0.001 | 0.978 | 0.954–0.997 | 0.044 |
TG, per mmol/L increased | 0.892 | 0.770–1.032 | 0.124 | – | – | – |
TCh, per mmol/L increased | 0.927 | 0.807–1.065 | 0.285 | – | – | – |
LDL-C, per mmol/L increased | 0.989 | 0.933–1.048 | 0.700 | – | – | – |
HDL-C, per mmol/L increased | 0.827 | 0.556–1.230 | 0.348 | – | – | – |
Multivessel lesions | 1.444 | 1.091–1.911 | 0.01 | 1.462 | 1.098–1.947 | 0.009 |
Time of symptom-wire, per hour increased | 1.003 | 0.994–1.013 | 0.477 | – | – | – |
IABP utility | 1.108 | 0.665–1.847 | 0.693 | – | – | – |
Shock index (per 0.1 increased) | 1.051 | 1.003–1.102 | 0.038 | – | – | – |
Anterior MI | 0.739 | 0.562–0.972 | 0.031 | – | – | – |
Onset stage of CS | ||||||
Non- CS (reference) | 1 | – | – | 1 | – | – |
CS on admission | 2.252 | 1.345–3.770 | 0.002 | 1.948 | 1.164–3.261 | 0.011 |
developed CS | 1.069 | 0.711–1.608 | 0.748 | 1.082 | 0.691–1.691 | 0.73 |
Killips Classification | ||||||
Killips = 1(reference) | 1 | – | – | – | – | – |
Killips = 2 | 1.34 | 0.933–1.925 | 0.113 | – | – | – |
Killips = 3 | 1.864 | 0.914–3.801 | 0.087 | – | – | – |
Killips = 4 | 2.389 | 1.423–4.013 | 0.001 | – | – | – |
post-PCI TIMI flow of IRA | ||||||
3 (reference) | 1 | – | – | 1 | – | – |
2 | 2.528 | 0.938–6.812 | 0.067 | 2.604 | 0.634–10.078 | 0.181 |
1 | 3.38 | 0.837–13.643 | 0.087 | 3.108 | 1.130–8.026 | 0.02 |