Cardiac deaths, neurologic injuries, multiorgan failures account for most AMICS deaths

The primary causes of death in patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) are heart failure, neurologic injury, and multiorgan failure (MOF), reports a recent study. Deaths from cardiac causes often occur within 13 hours of the first medical contact.

Researchers conducted a retrospective, multicentre, observational cohort study including 1,716 AMICS patients who had been treated between 2010 and 2017, of whom 904 (median age 72 years, 70 percent men) had died before discharge and were subjected to the present analysis.

Most of the nonsurvivors died from cardiac causes (54percent), followed by treatment withdrawals based on neurologic injuries (24 percent) and MOF (20 percent). The remaining 2 percent of deaths were attributed to other causes, such as sepsis, bleeding, and respiratory failure.

Those who died of cardiac causes were primarily older women (p<0.001) suffering from multivessel disease and had severely compromised left ventricular ejection fractions. Of note, cardiac deaths occurred after a median of 13 hours from emergency medical contact. MOF deaths had a similar demographic pattern, occurring 137 hours after first contact.

Meanwhile, deaths from neurologic injuries occurred mostly in young men, particularly among those who suffered from out-of-hospital cardiac arrests. Median time to mortality was 140 hours after medical contact.

“AMICS comprises a heterogeneous population with high mortality. Insight in timing and cause of death may improve understanding of the condition and aid individualization of treatment,” the researchers said.