17-year trends in incidence and prognosis of cardiogenic shock in patients with acute myocardial infarction in western Sweden

Redfors, Björn; Angerås, Oskar; Råmunddal, Truls; Dworeck, Christian; Haraldsson, Inger; Ioanes, Dan; Pétursson, Pétur; Libungan, Berglind; Odenstedt, Jacob; Stewart, Jason; Lodin, E.; Wahlin, Magnus; Albertsson, Per; Matejka, Göran; Ömerovic, Elmir

doi:10.1016/j.ijcard.2015.03.106

Cited by 71 publications

(60 citation statements)

References 26 publications

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“…Its pathogenic mechanism involves a decreased coronary perfusion pressure and reduced ventricular pumping of blood. This may lead to decreased cardiac output or target organ hypo-perfusion causing multiple organ dysfunction or significant systemic inflammatory response syndrome (Redfors et al 2015;Goldberg et al 2016). Another previous study suggested that an elevated white cell count in patients with STEMI is related to the body's stress response and changes due to coronary endothelial dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors for In-Hospital and Long-Term Survival in Patients with Acute ST-Segment Elevation Myocardial Infarction after Percutaneous Coronary Intervention

Hou

Gao

Feng

et al. 2017

Tohoku J. Exp. Med.

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Acute ST segment elevation myocardial infarction (STEMI) is one of the causes of death and disability in patients with cardiovascular diseases. This study aimed to investigate the prognostic factors of in-hospital and long-term survival in patients with acute STEMI undergoing percutaneous coronary intervention (PCI). Patients with STEMI undergoing PCI were divided into the death group (n = 54) and the survival group (n = 306) based on the outcomes during hospitalization. The routine blood and biochemistry tests, Killip classes and global registry of acute coronary events (GRACE) risk score were detected. The 1-, 2-and 3-year survival rates after PCI was observed through a 3-year follow-up. The survival factors, survival rates and multivariate analyses were conducted using Logistic regression analysis, Kaplan-Meier survival analysis and Cox proportional hazards regression. The incidence of cardiogenic shock and anterior wall MI (AWMI), the serum levels of γ-glutamyl endopeptidase (γ-GGT) and creatine kinase isoenzyme MB (CK-MB), Killip classes and GRACE risk score were higher in the death group, compared with the survival group. AWMI, cardiogenic shock, high serum levels of γ-GGT and CK-MB, Killip class III-IV and high GRACE risk scores were associated with in-hospital mortality. AWMI, cardiogenic shock, Killip class III-IV and high GRACE risk scores were correlated with a poor long-term survival. Our findings have demonstrated that AWMI, cardiogenic shock, high serum levels of γ-GGT and CK-MB, Killip class III-IV, and high GRACE risk scores are risk factors for in-hospital and long-term prognosis of acute STEMI patients.

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Section: Discussionmentioning

confidence: 99%

Prognostic Factors for In-Hospital and Long-Term Survival in Patients with Acute ST-Segment Elevation Myocardial Infarction after Percutaneous Coronary Intervention

Hou

Gao

Feng

et al. 2017

Tohoku J. Exp. Med.

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“…1 Although the incidence of CS in patients with STEMI has declined in the past decades, the mortality due to CS remains high (approximately 50%) despite all advances in management, medication and technology. 2 Early identification of the pre-shock state might play an important role in improving the prognosis of CS in STEMI patients.…”

Section: Methodsmentioning

confidence: 99%

Shock Index More Sensitive Than Cardiogenic Shock in ST-Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

Hemradj

Ottervanger

Boer³

et al. 2017

Circ J

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a small cohort of patients. 9 Recently, Spyridopoulos et al showed that SI is an independent and stronger predictor of long-term mortality in older patients with STEMI. 10 In that study, however, an unusual definition of CS (SBP <100 mmHg with HR >100 beats/min) was used, which makes it difficult to compare the results with previous studies and to extrapolate it into daily practice. Furthermore, they did not assess the optimal cut-off for SI, but used a self-chosen cut-off, which was different from previous studies. 8, 9 The independent prognostic value of SI as compared with CS in STEMI treated with primary PCI, is therefore still unclear. The aim of this study was to evaluate the independent impact of SI on 1-year mortality in a large cohort of patients with STEMI (largest until now), treated by primary PCI, and to compare this with CS. MethodsData for this study were collected from the prospective cohort of patients with STEMI at the Isala Hart Centrum, Zwolle, The Netherlands, from January 2000 to December 2011. Patients were diagnosed with STEMI if they had C ardiogenic shock (CS) has previously been shown to be a strong and independent predictor of both short-term and long-term mortality in patients with ST-elevation myocardial infarction (STEMI). 1 Although the incidence of CS in patients with STEMI has declined in the past decades, the mortality due to CS remains high (approximately 50%) despite all advances in management, medication and technology. 2 Early identification of the pre-shock state might play an important role in improving the prognosis of CS in STEMI patients.Several studies in non-cardiac shock patients suggested that shock index (SI), the ratio of heart rate (HR) to systolic blood pressure (SBP), is a sensitive tool for early recognition of septic, hypovolemic or obstructive shock. 3-7 The combination of HR and SBP may be more powerful than either HR or SBP alone, because early stages of shock are also taken into account. Therefore, SI can be a good marker of pre-shock. The predictive importance of SI in patients with STEMI has been shown in a recent study, but that study investigated only short-term mortality, and only 12% of the patients were treated by primary percutaneous coronary intervention (PCI). Background: Cardiogenic shock (CS) is a strong predictor of mortality in patients with ST-elevation myocardial infarction (STEMI), but there is evidence that shock index (SI), taking into account both blood pressure and heart rate, is a more sensitive and powerful predictor. We investigated the independent impact of SI and CS on 30-day and 1-year mortality in patients with STEMI, treated by primary percutaneous coronary intervention (PCI).

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“…4,57,[91][92][93] An analysis of the Nationwide Inpatient Sample Database between 2003 and 2010 reported an increase in the prevalence of CS from 6% to 10% in the overall population and from 7% to 12% among patients >75 years of age presenting with STEMI. 4 In-hospital mortality decreased from 45% to 34% over the same time frame, although mortality rates remained high (55%) in patients >75 years of age.…”

Section: Contemporary Outcomes Prognosis and Resource Use Trends Inmentioning

confidence: 99%

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Diepen¹,

Katz²,

Albert³

et al. 2017

Circulation

1,343

1,165

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Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities. Cardiogenic shock (CS) is a low-cardiac-output state resulting in life-threatening end-organ hypoperfusion and hypoxia.1,2 Acute myocardial infarction (MI) with left ventricular (LV) dysfunction remains the most frequent cause of CS. 1,3 Advances in reperfusion therapy have been associated with improvements in survival, but significant regional disparities in evidence-based care have been reported, and in-hospital mortality remains high (27%-51%).1,4-9 Management recommendations are distributed between disease-specific statements and guidelines, and a dedicated and comprehensive clinical resource in this area is lacking. Thus, consolidating the evidence to define contemporary best medical and surgical CS practices for both MI-associated CS and other types of CS may be an important step in knowledge translation to help attenuate disparities in evidence-based care.Regional systems of care coupled with treatment algorithms have improved survival in high-acuity time-sensitive conditions such as MI, out-of-hospital cardiac arrest (OHCA), and trauma.10-12 Applying a similar framework to CS management may lead to similar improvements in survival, and CS systems of care are emerging within existing regional cardiovascular emergency care networks; however, guidance from a national expert group on structure and systems of care has not been available. 13,14 Accordingly, the purposes of this American Heart Association (AHA) scientific statement on CS are to summarize our contemporary understanding of the epidemiology, pathophysiology, and in-hospital best care practices into a single clinical resource document; to suggest a stepwise management algorithm that integrates medical, surgical, and mechanical circulatory support (MCS) therapies; and to propose a Mission: Lifelinesupported pathway for the development of integrated regionalized CS systems of care. DEFINITION OF CSAcute cardiac hemodynamic instability may result from disorders that impair function of the myocardium, valves, conduction system, or pericardium, either in isolation HISTORICAL PERSPECTIVESBefore the routine use of early revascularization, MIassociated CS had an in-hospital mortality exceeding 80%. A registry trial of 250 patients with acute MI described the association between bedside physical examination (Killip classification) for the as...

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17-year trends in incidence and prognosis of cardiogenic shock in patients with acute myocardial infarction in western Sweden

Cited by 71 publications

References 26 publications

Prognostic Factors for In-Hospital and Long-Term Survival in Patients with Acute ST-Segment Elevation Myocardial Infarction after Percutaneous Coronary Intervention

Prognostic Factors for In-Hospital and Long-Term Survival in Patients with Acute ST-Segment Elevation Myocardial Infarction after Percutaneous Coronary Intervention

Shock Index More Sensitive Than Cardiogenic Shock in ST-Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

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