Types of immune responses and characteristics of the platelet hemostasis system in patients with myocardial infarction–associated cardiogenic shock: a cohort study

BACKGROUND: Myocardial infarction–associated cardiogenic shock (MI-CS) remains a condition with high mortality despite advances in reperfusion therapy. In recent years, increasing attention has been paid to the role of systemic inflammation and immunothrombosis in its pathogenesis.

AIM: This work aimed to assess the types of immune responses and the functional state of the platelet hemostatic system in patients with MI-CS and to analyze their association with clinical outcomes.

METHODS: This pilot cohort study included 24 patients with MI-CS. The type of immune response was determined based on leukocyte and lymphocyte counts, and platelet functional activity was assessed using low-frequency piezothromboelastography. Statistical analysis included nonparametric tests, multivariable logistic regression, and Kaplan–Meier survival analysis.

RESULTS: The mortality rate was 20.8% (n = 5). Activation of innate immunity predominated in 52.6% of survivors, whereas activation of adaptive immunity was observed in 80% of nonsurvivors (p = 0.048). In nonsurvivors, a trend toward shortening of the contact phase of coagulation was noted despite dual antiplatelet therapy. The lowest values of this parameter were recorded in cases with adaptive immune activation and immune areactivity.

CONCLUSION: Activation of adaptive immunity and platelet hyperactivation are associated with poor prognosis in MI-CS. Immunohematologic profiling may improve risk stratification and help optimize therapy.