Association Between Culprit Coronary Artery and Cardiogenic Shock in Patients With ST-Segment Elevation Myocardial Infarction

Background: Cardiogenic shock is the most severe complication of ST-segment elevation myocardial infarction (STEMI) and remains associated with high mortality despite advances in reperfusion therapy. The anatomical location of the culprit coronary artery may influence infarct size, ventricular dysfunction, and the development of cardiogenic shock. Objective: To analyze the association between the culprit coronary artery and the development of cardiogenic shock in patients with STEMI treated in a tertiary care hospital. Methods: A retrospective, observational, cross-sectional analytical study was conducted. Medical records of 177 patients diagnosed with STEMI between January 2023 and December 2024 were reviewed. Demographic variables, culprit coronary artery identified by coronary angiography, cardiogenic shock, and mortality were analyzed. Descriptive statistics were used, and associations between variables were evaluated using the chi-square test. Statistical significance was established at p < 0.05. Results: The mean age was 64 years. Most patients were male (77.4%). Cardiogenic shock occurred in 18 patients (10.2%). Overall mortality was 5.1%. The most frequently involved coronary artery was the left anterior descending artery (62.7%). A statistically significant association was found between cardiogenic shock and the dominant circumflex artery (p = 0.026). Conclusion: The dominant circumflex coronary artery was associated with the development of cardiogenic shock in patients with STEMI. Recognition of anatomical patterns of coronary involvement may contribute to early risk stratification and improved management of high-risk patients.