RIGHT VENTRICULAR DYSFUNCTION AS A MORTALITY DETERMINANT FOR PATIENTS WITH CARDIOGENIC SHOCK INDUCED BY ACUTE MYOCARDIAL INFARCTION
Amin Daoulah, Shaber Seraj, Ahmed F. Elmahrouk, Nooraldaem Yousif, Prashanth Panduranga, Wael Almahmeed, Abdulrahman Arabi, Mohammed Alshehri, Hatem Aloui, Amr A. Arafat, Mohammed A. Qutub, Waleed Alharbi, Rajesh Rajan, Mokhtar Abdirahman Kahin, Abdullah Al‐Enezi, Said Al Maashani, Taher Hassan, Jassim Alswuaidi, Awad Al‐Qahtani, Mubarak Aldossari, Mohammed Al‐Jarallah, Ali Alshehri, Abdelmaksoud Elganady, Badr Alzahrani, Abdulrahman Alqahtani, Faisal Omar M. Al Nasser, Haitham Amin, Mohamed N. Alama, Alaa Aldossari, Sultan Al Obaikan, Alsayed Ali Almarghany, Omar Kanbr, Ahmed A. Jamjoom, Youssef Elmahrouk, Ibrahim A. M. Abdulhabeeb, Mohammed Balghith, Ahmad Hersi, Abeer Said Mohamed Al Rawahi, Marwa Abd Elghany Albasiouny Alkholy, Adnan Fathey Hussien, Abdulrahman Almoghairi, Mohamed N. Alama, Mohamed Ajaz Ghani, Ayman Uthman Alhussini, Ayman Basardah, Bandar Alshehri, Laura AlObaid, Sara Shawki Saati, Seraj Abualnaja, Tarique Shahzad Chachar, Hassan Khan, Shahrukh Hashmani, Ahmed A. Ghonim, Khalid Almerri, Razan waleed W Alsofayan, Abeer M. Shawky, Amir Lotfi
Abstract
ABSTRACT: Background: Cardiogenic shock (CS) secondary to acute myocardial infarction (AMI) is a major cause of in-hospital mortality. With the addition of right ventricular dysfunction (RVD), it is associated with poorer outcomes. This study examines the impact of RVD on mortality in CS-AMI patients, highlighting the importance of early RVD identification and tailored management. Methods: Data from the Gulf Cardiogenic Shock (Gulf-CS) registry-a multicenter registry of CS-AMI patients from six Gulf countries-were analyzed to compare in-hospital and long-term outcomes for patients with and without RVD. RVD was defined by echocardiographic criteria: tricuspid annular plane systolic excursion <17 mm, S' wave <12 cm/s, and tricuspid annular plane systolic excursion/ pulmonary artery systolic pressure ratio <0.34. Multivariable logistic and Cox regression models were used to identify in-hospital and follow-up mortality predictors. Results: Among 1,513 CS-AMI patients, RVD was independently associated with higher in-hospital mortality (55.87% vs. 42.89%, P < 0.001) and lower survival at 6, 12, 18, and 24 months (58%, 35%, 18%, and 6% vs. 73%, 53%, 38%, and 30%; P < 0.001). Predictors of in-hospital mortality included advanced Society for Cardiovascular Angiography and Interventions shock stage, cardiac arrest, age, non-ST-elevation myocardial infarction, number of vessels affected, and elevated creatinine, while follow-up mortality was associated with advanced Society for Cardiovascular Angiography and Interventions stage, reduced left ventricular ejection fraction, elevated blood urea nitrogen, history of CABG and comorbidities including chronic obstructive pulmonary disease and prior cerebrovascular accident. Conclusion: RVD is a significant independent predictor of both in-hospital and long-term mortality in CS-AMI, highlighting the need for early RVD assessment and specific interventions. This study's findings support the integration of RV-focused management strategies to improve survival outcomes in this high-risk population.