Composite trends of cardiogenic shock complicating acute myocardial infarction

Abstract

This article refers to 'Trends in cardiogenic shock complicating acute myocardial infarction' by N. Aissaoui et al., published in this issue on pages 664-672.Cardiogenic shock (CS) is the leading cause of death in patients with acute myocardial infarction (AMI), with in-hospital mortality as high as 40-50%. [1][2][3][4][5][6][7][8][9][10][11][12] Although improved AMI care had significantly reduced the incidence of CS in the early 2000s, more recent observational studies showed varying trends with a decreased, stable or even slightly increased (usually when administrative datasets are used) incidence of CS, currently ranging from 3% to 15% of AMI cases (Figure 1). [1][2][3][4][5][6][7][8][9][10][11][12] These conflicting data and the wide ranges might reflect differences in definitions and patient profiles, since CS patients are a heterogeneous population, encompassing those at high risk of developing shock due to isolated myocardial dysfunction to those critically ill patients with severe multi-organ dysfunction or resuscitated cardiac arrest.In this issue of the Journal, data from three nationwide French registries conducted 5 years apart and including approximately 10 000 consecutive AMI patients admitted to intensive cardiovascular care units are presented. 13 The overall prevalence of CS complicating AMI halved in a decade: from 5.9% in 2005 to 2.8% in 2015. This reduction was observed both for CS developing prior to admission (primary CS), and even more for CS developing after hospitalization and coronary reperfusion (secondary CS). However, the number of CS patients presenting after out-of-hospital cardiac arrest (OHCA) increased over time. 13 Despite an increase in early medications and percutaneous coronary intervention (PCI), 1-year mortality remained exceptionally high (58%) and did not change over the decade of observation. This was the result of different trends in primary vs. secondary CS: mortality decreased significantly from 60% to 38% (P = 0.038) in patients with primary CS, but remained unchanged in patients developing secondary CS (from 64.5% to 69.1%; P = 0.731). 13 The decreasing incidence of CS developed during hospitalization, more evident in western countries, might be due to an The opinions expressed in this article are not necessarily those of the Editors of the European Journal of Heart Failure or of the European Society of Cardiology. earlier arrival at hospital and an increased usage of timely PCI with reduction in infarct size and subsequent incidence of mechanical complications and acute heart failure. On the other hand, with improvements in AMI network and medical care leading to more frequent and rapid transportation of even sicker patients, the increased incidence of advanced heart failure developing after AMI, early and careful attention to the maintenance of acceptable haemodynamic parameters, novel treatment options and adherence to effective secondary prevention strategies, CS on admission now represents the majority of CS cases. For the same reason, resuscitated OHCA patien...

Prognosis of cardiogenic shock secondary to culprit left main coronary artery lesion‐related myocardial infarction

“…In the last 20 years, most of the cohorts report a 40–60% in‐hospital or 30 day mortality. 19 This occurs despite the widespread use of emergent coronary revascularization in the context of AMICS. The SHOCK trial showed a trend towards improvement in 30 day mortality and a significant reduction in 6 month mortality among patients with AMICS undergoing urgent revascularization.…”

“…AMICS is an entity associated with high mortality. In the last 20 years, most of the cohorts report a 40–60% in‐hospital or 30 day mortality 19 . This occurs despite the widespread use of emergent coronary revascularization in the context of AMICS.…”

Correlations of visfatin with severity of acute myocardial infarction, cardiovascular risk factors and atrial fibrillation after percutaneous coronary intervention

“…AMI is a critical disease of coronary atherosclerosis, with its major pathogenic factor being secondary thrombosis caused by the rupture and erosion of unstable plaques in the coronary artery. This results in coronary occlusion and myocardial ischemia and necrosis [9] . Visfatin, a type of adipocytokine, has multiple biological effects and is closely associated with the occurrence and development of hypertension, heart failure, and coronary heart disease according to a large amount of research evidence in recent years.…”

Contemporary Management of Cardiogenic Shock Complicating Acute Myocardial Infarction

“…Despite the introduction of myocardial revascularisation therapy and an overall improvement in mechanical reperfusion strategies [ 2 , 3 , 4 ], CS remains the leading cause of in-hospital death in patients with AMI, with an in-hospital and 1-year mortality rate of 40% and 50%, respectively [ 5 ]. Some recent registries reported an increased mortality rate, which may be related to changes in the mean age and risk profiles of CS patients [ 6 , 7 ].…”