{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T23:33:24Z","timestamp":1780961604222,"version":"3.54.1"},"reference-count":32,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2021,2,1]],"date-time":"2021-02-01T00:00:00Z","timestamp":1612137600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>As demonstrated by earlier studies, pre-hospital triage with trans-telephonic electrocardiogram (TTECG) and direct referral for catheter therapy shows great value in the management of out-of-hospital chest pain emergencies. It does not only improve in-hospital mortality in ST-segment elevation myocardial infarction, but it has also been identified as an independent predictor of higher in-hospital survival rate. Since TTECG-facilitated triage shortens both transport time and percutaneous coronary intervention (PCI)-related procedural time intervals, it was hypothesized that even high-risk patients with acute coronary syndrome (ACS) and cardiogenic shock (CS) might also benefit from TTECG-based triage. Here, we decided to examine our database for new triage- and left ventricular (LV) function-related parameters that can influence in-hospital mortality in ACS complicated by CS. ACS patients were divided into two groups, namely, (1) hospital death patients (n = 77), and (2) hospital survivors (control, n = 210). Interestingly, TTECG-based consultation and triage of CS and ACS patients were confirmed as significant independent predictors of lower hospital mortality risk (odds ratio (OR) 0.40, confidence interval (CI) 0.21\u20130.76, p = 0.0049). Regarding LV function and blood chemistry, a good myocardial reperfusion after PCI (high area at risk (AAR) blush score\/AAR LV segment number; OR 0.85, CI 0.78\u20130.98, p = 0.0178) and high glomerular filtration rate (GFR) value at the time of hospital admission (OR 0.97, CI 0.96\u20130.99, p = 0.0042) were the most crucial independent predictors of a decreased risk of in-hospital mortality in this model. At the same time, a prolonged time interval between symptom onset and hospital admission, successful resuscitation, and higher peak creatine kinase activity were the most important independent predictors for an increased risk of in-hospital mortality. In ACS patients with CS, (1) an early TTECG-based teleconsultation and triage, as well as (2) good myocardial perfusion after PCI and a high GFR value at the time of hospital admission, appear as major independent predictors of a lower in-hospital mortality rate.<\/jats:p>","DOI":"10.3390\/s21030969","type":"journal-article","created":{"date-parts":[[2021,2,1]],"date-time":"2021-02-01T11:40:48Z","timestamp":1612179648000},"page":"969","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Predictors of Hospital Mortality in Patients with Acute Coronary Syndrome Complicated by Cardiogenic Shock"],"prefix":"10.3390","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9880-0425","authenticated-orcid":false,"given":"G\u00e1bor Tam\u00e1s","family":"Szab\u00f3","sequence":"first","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e1s","family":"\u00c1goston","sequence":"additional","affiliation":[{"name":"The III: Department of Internal Medicine, Szabolcs\u2013Szatm\u00e1r\u2013Bereg County Hospitals and University Teaching Hospital, 4400 Ny\u00edregyh\u00e1za, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00e1bor","family":"Csat\u00f3","sequence":"additional","affiliation":[{"name":"Hungarian National Ambulance Service, 1024 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ildik\u00f3","family":"R\u00e1cz","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8719-2126","authenticated-orcid":false,"given":"Tam\u00e1s","family":"B\u00e1r\u00e1ny","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00e1bor","family":"Uzonyi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Uzsoki Hospital, 1145 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikl\u00f3s","family":"Szokol","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bal\u00e1zs","family":"S\u00e1rm\u00e1n","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Uzsoki Hospital, 1145 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c9va","family":"Jebelovszki","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, University of Szeged, 6725 Szeged, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Istv\u00e1n Ferenc","family":"\u00c9des","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6972-0781","authenticated-orcid":false,"given":"D\u00e1niel","family":"Czuriga","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rudolf","family":"Kolozsv\u00e1ri","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zolt\u00e1n","family":"Csan\u00e1di","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Istv\u00e1n","family":"\u00c9des","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2817-6900","authenticated-orcid":false,"given":"Zsolt","family":"K\u0151szegi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary"},{"name":"The III: Department of Internal Medicine, Szabolcs\u2013Szatm\u00e1r\u2013Bereg County Hospitals and University Teaching Hospital, 4400 Ny\u00edregyh\u00e1za, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,2,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e56","DOI":"10.1161\/CIR.0000000000000659","article-title":"Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association","volume":"139","author":"Benjamin","year":"2019","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1093\/eurheartj\/ehx393","article-title":"2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)","volume":"39","author":"Ibanez","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Collet, J.P., Thiele, H., Barbato, E., Barth\u00e9l\u00e9my, O., Bauersachs, J., Bhatt, D.L., Dendale, P., Dorobantu, M., Edvardsen, T., and Folliguet, T. (2020). 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur. Heart J.","DOI":"10.15829\/1560-4071-2021-4418"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ccl.2017.08.001","article-title":"Evaluation of Chest Pain and Acute Coronary Syndromes","volume":"36","author":"Chang","year":"2018","journal-title":"Cardiol. Clin."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1016\/j.jelectrocard.2011.01.009","article-title":"Transtelephonic electrocardiography for managing out-of-hospital chest pain emergencies","volume":"44","author":"Haro","year":"2011","journal-title":"J. Electrocardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/j.jelectrocard.2014.02.007","article-title":"Transtelephonic electrocardiography in the management of patients with acute coronary syndrome","volume":"47","author":"Papai","year":"2014","journal-title":"J. Electrocardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1093\/eurheartj\/ehv051","article-title":"Management of cardiogenic shock","volume":"36","author":"Thiele","year":"2015","journal-title":"Eur. Heart J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e011991","DOI":"10.1161\/JAHA.119.011991","article-title":"Cardiogenic Shock","volume":"8","author":"Vahdatpour","year":"2019","journal-title":"J. Am. Heart Assoc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1002\/ejhf.260","article-title":"Clinical picture and risk prediction of short-term mortality in cardiogenic shock","volume":"17","author":"Harjola","year":"2015","journal-title":"Eur. J. Heart Fail."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1093\/eurheartj\/ehw128","article-title":"2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC","volume":"37","author":"Ponikowski","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/0002-9149(67)90023-9","article-title":"Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients","volume":"20","author":"Killip","year":"1967","journal-title":"Am. J. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1056\/NEJMoa1208410","article-title":"Intraaortic balloon support for myocardial infarction with cardiogenic shock","volume":"367","author":"Thiele","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1638","DOI":"10.1016\/S0140-6736(13)61783-3","article-title":"Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): Final 12 month results of a randomised, open-label trial","volume":"382","author":"Thiele","year":"2013","journal-title":"Lancet"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1093\/eurheartj\/ehy394","article-title":"2018 ESC\/EACTS Guidelines on myocardial revascularization","volume":"40","author":"Neumann","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/j.compmedimag.2007.06.008","article-title":"Holistic polar map for integrated evaluation of cardiac imaging results","volume":"31","author":"Koszegi","year":"2007","journal-title":"Comput. Med. Imaging Graph."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1053\/euhj.1997.0856","article-title":"Segmental comparison between coronary angiography and positron emission tomography reveals low predictive value of epicardial flow for viability","volume":"19","author":"Koszegi","year":"1998","journal-title":"Eur. Heart J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1093\/eurheartj\/ehn542","article-title":"Computer-assisted myocardial blush quantification after percutaneous coronary angioplasty for acute myocardial infarction: A substudy from the TAPAS trial","volume":"30","author":"Vogelzang","year":"2009","journal-title":"Eur. Heart J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1016\/j.ahj.2011.04.014","article-title":"Quantitative Blush Evaluator accurately quantifies microvascular dysfunction in patients with ST-elevation myocardial infarction: Comparison with cardiovascular magnetic resonance","volume":"162","author":"Porto","year":"2011","journal-title":"Am. Heart. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1177\/1357633X18814335","article-title":"The transtelephonic electrocardiogram-based triage is an independent predictor of decreased hospital mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention","volume":"26","author":"Papai","year":"2020","journal-title":"J. Telemed. Telecare"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1177\/2048872614527009","article-title":"Pre-hospital electrocardiogram triage with tele-cardiology support is associated with shorter time-to-balloon and higher rates of timely reperfusion even in rural areas: Data from the Bari-Barletta\/Andria\/Trani public emergency medical service 118 registry on primary angioplasty in ST-elevation myocardial infarction","volume":"3","author":"Brunetti","year":"2014","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1016\/j.jcin.2012.07.013","article-title":"Improved survival associated with pre-hospital triage strategy in a large regional ST-segment elevation myocardial infarction program","volume":"5","author":"Chan","year":"2012","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1016\/j.ijcard.2015.03.138","article-title":"Lower mortality with pre-hospital electrocardiogram triage by telemedicine support in high risk acute myocardial infarction treated with primary angioplasty: Preliminary data from the Bari-BAT public Emergency Medical Service 118 registry","volume":"185","author":"Brunetti","year":"2015","journal-title":"Int. J. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.ijcard.2017.01.055","article-title":"Pre-hospital electrocardiogram triage with telemedicine near halves time to treatment in STEMI: A meta-analysis and meta-regression analysis of non-randomized studies","volume":"232","author":"Brunetti","year":"2017","journal-title":"Int. J. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1089\/tmj.2011.0158","article-title":"Telemedicine for the reduction of myocardial infarction mortality: A systematic review and a meta-analysis of published studies","volume":"18","author":"Cadeddu","year":"2012","journal-title":"Telemed. J. E Health"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.jcin.2010.11.007","article-title":"The STAT-MI (ST-Segment Analysis Using Wireless Technology in Acute Myocardial Infarction) trial improves outcomes","volume":"4","author":"Oghlakian","year":"2011","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.ijcard.2016.05.009","article-title":"The role of levosimendan in acute heart failure complicating acute coronary syndrome: A review and expert consensus opinion","volume":"218","author":"Nieminen","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1002\/clc.22564","article-title":"Cardiogenic Shock: Failure of Oxygen Delivery and Oxygen Utilization","volume":"39","author":"Lim","year":"2016","journal-title":"Clin. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"618","DOI":"10.7326\/0003-4819-149-9-200811040-00005","article-title":"Ten-year trends in the incidence and treatment of cardiogenic shock","volume":"149","author":"Jeger","year":"2008","journal-title":"Ann. Intern. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1824","DOI":"10.1016\/j.jcin.2018.06.030","article-title":"Delays in Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction Patients Presenting With Cardiogenic Shock","volume":"11","author":"Kochar","year":"2018","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1093\/eurheartj\/ehy004","article-title":"Impact of treatment delay on mortality in ST-segment elevation myocardial infarction (STEMI) patients presenting with and without haemodynamic instability: Results from the German prospective, multicentre FITT-STEMI trial","volume":"39","author":"Scholz","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2511","DOI":"10.1001\/jama.295.21.2511","article-title":"Early revascularization and long-term survival in cardiogenic shock complicating acute myocardial infarction","volume":"295","author":"Hochman","year":"2006","journal-title":"JAMA"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2671","DOI":"10.1093\/eurheartj\/ehz363","article-title":"Management of cardiogenic shock complicating myocardial infarction: An update 2019","volume":"40","author":"Thiele","year":"2019","journal-title":"Eur. Heart J."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/21\/3\/969\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:18:12Z","timestamp":1760159892000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/21\/3\/969"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,1]]},"references-count":32,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,2]]}},"alternative-id":["s21030969"],"URL":"https:\/\/doi.org\/10.3390\/s21030969","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,1]]}}}