ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Intensive Care Cardiovascular Medicine
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1625202
This article is part of the Research TopicFrom Laboratory Insights to Clinical Strategies in Cardiogenic ShockView all 3 articles
Factors Associated with Critical Care Needs in Patients Presenting with ST-Elevation Myocardial Infarction (STEMI) : Impact of Early Decompensation and Culprit Lesions
Provisionally accepted
Jack Jnani1*
Spencer Weintraub1Aditya Sood1Austin Cheng1Maikel Kamel1Riya George1Brandon Impastato1Shreya Srivastava1Ji-Cheng Hsieh1Yisrael Wallach1Allan Lin1Andrew Tsai1Jack Alboucai1Kishen Bulsara1Matthew Griffin1Miguel Alvarez Villela2
Matthew Pierce1- 1North Shore University Hospital, Manhasset, United States
- 2lenox hill hospital, new york, United States
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Background: Patients with ST-elevation myocardial infarction (STEMI) are often admitted to the cardiac intensive care unit (CICU), though not all require advanced therapies. Identifying predictors of critical care need may improve triage and resource allocation. Methods: We performed a retrospective cohort study of 758 patients admitted with STEMI to a quaternary care CICU from 2018–2022. The primary outcome was critical care need, which was defined as use of mechanical ventilation, titratable infusions (vasoactive, sedative, or anti-arrhythmic), or mechanical circulatory support. Multivariable logistic regression was used to identify predictors of critical care need. Results: 141 out of 758 patients (18.6%) utilized critical care resources, with the majority initiated before CICU admission (71%). We found that a history of chronic kidney disease (OR 4.3, 0.96-17.5, p=0.05), STEMI in the post-COVID era (OR 2.7, 95% CI 1.45-5.09, p=0.002), a Modified Shock Index on admission ≥ 0.93 (OR 4.04, 2.04-8.08, p<0.001), and a lower ejection fraction (OR 0.97, 0.94-0.99, p=0.007) were independent predictors of having critical care needs. Presence of a severe coronary stenosis (>70%), which was typically revascularized, did not increase critical care need, whereas multivessel coronary disease significantly did (OR 3.06, 1.64-5.83, p<0.001). Conclusion: The majority of patients in our cohort did not require critical care resources after a STEMI, and a majority of those that did developed those needs prior to admission. A history of chronic kidney disease, elevated Modified Shock Index, reduced ejection fraction, and multivessel disease were associated with critical care needs while culprit vessel involvement was not.
Keywords: ST-segment myocardial infarction (STEMI), Critical care need, Cardiac Catheterization, Culprit lesion, Modified shock index, Mortality
Received: 08 May 2025; Accepted: 16 Sep 2025.
Copyright: © 2025 Jnani, Weintraub, Sood, Cheng, Kamel, George, Impastato, Srivastava, Hsieh, Wallach, Lin, Tsai, Alboucai, Bulsara, Griffin, Villela and Pierce. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jack Jnani, jakejayy230@gmail.com
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