Decade-Long Trends (2001–2011) in the Incidence and Hospital Death Rates Associated with the In-Hospital Development of Cardiogenic Shock after Acute Myocardial Infarction

Abstract

Background Limited information is available about relatively contemporary trends in the incidence and hospital case-fatality rates (CFRs) of cardiogenic shock in patients hospitalized with acute myocardial infarction (AMI).The purpose of this population-based study was to describe decade long trends (2001-2011) in the incidence and hospital CFRs for patients who developed cardiogenic shock during hospitalization for an AMI. Methods and Results The study population consisted of 5,686 residents of central MA hospitalized with AMI at all 11 medical centers in the Worcester, MA, metropolitan area during six biennial periods between 2001 and 2011, who did not have cardiogenic shock at the time of hospital presentation. On average, 3.7% of these patients developed cardiogenic shock during their acute hospitalization with nonsignificant and inconsistent trends noted over time in both crude (3.7% in 2001/2003; 4.5% in 2005/2007; 2.7% in 2009/2011; p=0.19) and multivariable adjusted analyses. The overall in-hospital CFR for patients who developed cardiogenic shock was 41.4 %. The crude and multivariable adjusted odds of dying after cardiogenic shock declined during the most recent study years (47.1% dying in 2001/2003, 42.0% dying in 2005/2007, and 28.6% dying in 2009/2011). Increases in the use of evidence-based cardiac medications and interventional procedures paralleled the increasing hospital survival trends. Conclusions We found suggestions of a decline in the death, but not incidence, rates of cardiogenic shock over time. These encouraging trends in hospital survival are likely due to advances in the early recognition and aggressive management of patients who develop cardiogenic shock.

Ten‐Year (2001–2011) Trends in the Incidence Rates and Short‐Term Outcomes of Early Versus Late Onset Cardiogenic Shock After Hospitalization for Acute Myocardial Infarction

“…Whereas the in‐hospital CFRs improved over time for those with in‐hospital CS, perhaps as a result of early and more‐effective treatment approaches, patients suffering prehospital CS experienced poorer outcomes. One potential explanation for this observation is that patients hospitalized with AMI in recent years have a greater burden of comorbid conditions present coupled with less‐than‐optimal care‐seeking behaviors and prolonged prehospital delay times 8. Another possible reason for our finding, which is supported by the observation that fewer patients with prehospital CS underwent an invasive procedure during their hospitalization than did participants free from prehospital CS, is that patients with prehospital CS were deemed to be too sick and at too high risk at the time of hospital admission to receive selected therapies.…”

“…The frequency of CS has either slightly declined or remained unchanged over time, with reported rates ranging from 3% through 10%, depending, in part, on the definitions used to define CS and the characteristics of the populations studied 7, 8, 9, 10, 11. Although the hospital case‐fatality rates associated with CS have encouragingly declined over time, CS remains a major cause of death among patients hospitalized with AMI 7, 8, 9, 10, 11…”

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

“…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.…”

Prevalence, Causes, and Predictors of 30‐Day Readmissions Following Hospitalization With Acute Myocardial Infarction Complicated By Cardiogenic Shock: Findings From the 2013–2014 National Readmissions Database

“…A more recent analysis of the NCDR‐ACTION registry for 2007–2011 suggested that 2 of 3 such patients survived the index hospitalization . Despite advances in anticoagulation and mechanical support devices over the past few years, the in‐hospital mortality rate has been ≈30% in recent years . With more patients surviving their index hospitalization, data regarding short‐ and longer‐term prognosis of this high‐risk population have been limited.…”