# Fluid balance trajectories and prognosis in patients with acute myocardial infarction complicated by cardiogenic shock: a group-based trajectory model approach

## TL;DR

This study examines how fluid balance patterns affect survival in patients with heart attacks complicated by cardiogenic shock, finding that negative fluid balance is linked to better outcomes.

## Contribution

The study introduces a group-based trajectory model to identify fluid balance patterns and their association with survival in acute myocardial infarction with cardiogenic shock.

## Key findings

- Patients with stable or rapidly declining negative fluid balance had higher survival rates.
- Fluid overload was significantly associated with increased mortality risk.
- The GBTM approach effectively stratified AMI-CS patients into distinct risk groups.

## Abstract

Fluid management is crucial in the treatment of patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS), yet the optimal strategy remains unclear. This study aims to evaluate the association between fluid balance (FB) trajectories and prognosis in AMI-CS patients.

This study utilized data from the MIMIC-IV database, including patients diagnosed with AMI-CS. A Group-Based Trajectory Model (GBTM) was applied to identify patient groups with similar FB trends. The association between different FB trajectories and patient survival was assessed using Kaplan–Meier survival analysis and Cox regression models. Additionally, subgroup and sensitivity analyses were conducted to validate the robustness of the results.

A total of 533 AMI-CS patients were included. The 4-group trajectory model showed good fit (AIC = 19,937.75; minimum AvePP = 0.81). Four FB trajectory patterns were identified: trajectory 1 (stable negative balance), trajectory 2 (rapid decline to negative balance), trajectory 3 (persistent positive balance), and trajectory 4 (high-level decreasing). Kaplan–Meier survival analysis revealed that patients in trajectories 1 and 2 had higher survival rates, while those in the fluid overload group had a significantly higher risk of death compared to the non-overload group. Cox regression analysis further demonstrated that, compared to trajectory 2, trajectory 3 was associated with a significantly increased mortality risk, while trajectory 1 showed no statistically significant difference. Subgroup and sensitivity analyses were consistent, confirming the robustness of the study findings.

Among the dynamic FB patterns in AMI-CS patients, stable negative balance or rapid transition to negative balance is associated with the best prognosis. The GBTM approach helps identify different risk strata within the AMI-CS patient population.