Acute myocardial infarction vs acute decompensated heart failure in cardiogenic shock: a systematic review and meta-analysis of clinical phenotypes and mortality
EUROPEAN JOURNAL OF HEART FAILURE, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Basım Tarihi: 2026
- Doi Numarası: 10.1093/ejhf/xuag186
- Dergi Adı: EUROPEAN JOURNAL OF HEART FAILURE
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE, Academic Search Ultimate (EBSCO), Biomedical Reference Collection: Corporate Edition (EBSCO)
- Dokuz Eylül Üniversitesi Adresli: Evet
Özet
Aims Cardiogenic shock (CS) encompasses distinct phenotypes driven by acute myocardial infarction-driven CS (AMI-CS) and acutely decompensated heart failure-driven CS (ADHF-CS). Consolidated comparative evidence remains limited. This meta-analysis compared presentation, management, and short-term mortality between AMI-CS and ADHF-CS. Methods Observational studies between 2019 and 2025 comparing AMI-CS and ADHF-CS were summarized in accordance with Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) 2020. Random-effects models were used to estimate odds ratios (ORs) and mean differences with 95% confidence intervals. The primary outcome was short-term (in-hospital/30-day) mortality. Results Twenty-nine studies (497 368 patients) were pooled. AMI-CS patients were older (mean difference 4.76 years, 95% confidence interval .37-9.14) with higher ejection fraction at presentation (mean difference 6.04%, 4.53-7.55). AMI-CS presented more fulminantly, with greater odds of cardiac arrest (OR 2.03, 1.04-3.98) and Society for Cardiovascular Angiography and Interventions Stage D/E shock (OR 1.50, 1.33-1.70); invasive filling pressures did not differ. Phenotype-defining variables (left ventricular ejection fraction, Society for Cardiovascular Angiography and Interventions stage, invasive haemodynamics) were extractable in <1.1% of the pooled cohort. Temporary mechanical circulatory support was more frequent in AMI-CS (any device OR 5.44, 2.83-10.46; intra-aortic balloon pump OR 4.73; percutaneous ventricular assist device OR 2.67; veno-arterial extracorporeal membrane oxygenation OR 3.27). Destination therapy was much less frequent (OR .09, .03-.24); major bleeding was modestly higher (OR 1.36, 1.02-1.82). Short-term mortality was higher in AMI-CS (OR 1.58, 1.06-2.37). Conclusion AMI-CS presents more fulminantly than ADHF-CS, with markedly greater mechanical support use and higher short-term mortality. A dual-axis framework integrating shock severity with aetiology is proposed as an organizing principle for hypothesis generation; validation in prospective, phenotype-rich cohorts is required.