AIMS: To determine the current state of the use of reperfusion and adjunctive therapies and in-hospital outcomes in European Society of Cardiology (ESC) member and affiliated countries for patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS). METHODS AND RESULTS: ESC EurObservational Research Programme prospective international cohort study of admissions with STEMI within 24 h of symptom onset (196 centres; 26 ESC member and 3 affiliated countries). Of 11 462 patients enrolled, 448 (3.9%) had CS. Patients with compared to patients without CS, less frequently received primary percutaneous coronary intervention (PCI) (65.5% vs. 72.2%) and fibrinolysis (15.9% vs. 19.0), and more often had no reperfusion therapy (19.0% vs. 8.5%). Mechanical support devices (intraaortic ballon pump 11.2%, extracoporeal membrane oxygenation 0.7%, other 1.1%) were used infrequently in CS. Bleeding definition academic research consortium 2-5 bleeding complications (10.1% vs. 3.0%, P < 0.01) and stroke (4.2% vs. 0.9%, P < 0.01) occurred more frequently in patients with CS. In-hospital mortality was 10-fold higher (35.5% vs. 3.1%) in patients with CS. Mortality in patients with CS in the groups with PCI, fibrinolysis, and no reperfusion therapy were 27.4%, 36.6%, and 62.4%, respectively. CONCLUSION: In this multi-national registry, patients with STEMI complicated by CS less frequently receive reperfusion therapy than patients with STEMI without CS. Early mortality in patients with CS not treated with primary PCI is very high. Therefore, strategies to improve clinical outcome in STEMI with CS are needed.

Cardiac Rehabilitation Research Center Cardiovascular Research Institute Isfahan University of Medical Sciences Isfahan Iran

Department of Cardiology Jagiellonian University Krakow Poland

EURObservational Research Program European Society of Cardiology Sophia Antipolis France

Hôpital Européen G Pompidou Service de Cardiologie Paris France

Hospital Rudolfstiftung Vienna Austria

Institute of Cardiovascular Sciences University of Birmingham Birmingham UK

Internal Cardiology Department Faculty of Medicine of Masaryk University University Hospital Brno Brno Czech Republic

Kermanshah University of Medical Sciences Kermanshah Iran

Klinikum der Stadt Ludwigshafen and Institut für Herzinfarktforschung Ludwigshafen am Rhein Germany

Leeds Institute of Cardiovascular and Metabolic Medicine University of Leeds Leeds UK

Mansoura Faculty of Medicine Cardiology department Mansoura Egypt

Maria Cecilia Hospital GVM Care and Research Cotignola Italy

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