INDEPENDENT PREDICTORS OF LATE-ONSET CARDIOGENIC SHOCK IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION AT CHO RAY HOSPITAL
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Abstract
Background: Late-onset cardiogenic shock is a severe complication of acute myocardial infarction (AMI). Patients may initially present without overt hemodynamic instability but subsequently deteriorate rapidly and develop circulatory failure during hospitalization. Therefore, early identification of predictive factors is important for risk stratification and timely management.
Objective: To identify baseline clinical and paraclinical factors that independently predict late-onset cardiogenic shock in patients with AMI.
Methods: This descriptive cross-sectional study with longitudinal follow-up included 1,083 patients with AMI who had no cardiogenic shock at admission and were treated at Cho Ray Hospital from April 2025 to April 2026. Late-onset cardiogenic shock was identified during hospitalization. Clinical, laboratory, electrocardiographic, and echocardiographic data were collected at admission.
Results: Late-onset cardiogenic shock occurred in 55 patients (5.1%). Independent predictors included age per 10-year increase (aOR 1.72; 95% CI: 1.29–2.31), right ventricular STEMI (aOR 35.50; 95% CI: 7.56–166.71), systolic blood pressure per 10-mmHg decrease (aOR 1.23; 95% CI: 1.02–1.49), Killip class II–III (aOR 3.10; 95% CI: 1.51–6.40), blood urea nitrogen per 5-mg/dL increase (aOR 1.19; 95% CI: 1.02–1.40), right bundle branch block (aOR 5.84; 95% CI: 1.83–18.62), and left ventricular ejection fraction per 5% decrease (aOR 1.36; 95% CI: 1.12–1.64).
Conclusion: Late-onset cardiogenic shock occurred in 5.1% of patients with AMI. Older age, right ventricular STEMI, lower systolic blood pressure, Killip class II–III, elevated blood urea nitrogen, right bundle branch block, and reduced left ventricular ejection fraction were independent predictors. Early identification of these factors may facilitate risk stratification, closer monitoring, and appropriate treatment strategies to prevent progression to late-onset cardiogenic shock.
Keywords
late-onset cardiogenic shock, acute myocardial infarction, predictors, right bundle branch block, left ventricular ejection fraction
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References
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