Temporal Trends in Cardiogenic Shock Treatment and Outcomes Among Ontario Patients With Myocardial Infarction Between 1992 and 2008

Abstract

Background-Clinical trials have demonstrated that emergent revascularization improves survival of patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). However, rates of uptake and impact on outcomes remain uncertain.

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

“…The majority of previously published studies 1, 2, 8, 26 , including the findings from multinational randomized trials such as the Global Utilization of Steptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I, 1990-1993) and the follow up study (GUSTO-III, 1995-1997) had observed relatively stable trends in the frequency of this devastating complication over the past few decades, despite significant advances in the medical management of patients hospitalized with AMI. In contrast, a limited number of international studies 10, 11 , including three nationwide French registries conducted 5 years apart, observed declining trends in the incidence rates of cardiogenic shock over time (6.9% in 1995; 5.7% in 2005).…”

Fifteen‐year trends in the management of cardiogenic shock and associated 1‐year mortality in elderly patients with acute myocardial infarction: the FAST‐MI programme

“…In addition, several studies have suggested that PCI improved short‐term survival in patients with CS, with survival contingent on the successful establishment of coronary reperfusion . In all studies that assessed changing trends in the incidence and outcome of CS after AMI, an increase in the use of PCI was found, with a concomitant decline in short‐term mortality …”

Twenty-Year Trends in the Incidence and Outcome of Cardiogenic Shock in AMIS Plus Registry

“…Several studies have shown a variable decrease in the rates of CS ranging from 1.8% to 1.4% between 2000 and 2013 in a study from Israel, 1 from 12% in 1995 to 4% in 2012 2 or from 3.4% in 1992 to 2.6% in 2008. 3 In summary, a decrease in the incidence of CS is generally documented after the late 1990's. 4 While in the last decade (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011), a relatively stable incidence of 3.7% 5 and 5.2% has been reported, 6,7 2 recent studies document an increasing incidence of CS during the last decade (2003-2010) from 7.9 to 10.1 in patients ST-segment-elevation myocardial infarction (STEMI) 8 and non-STEMI patients.…”

“…9 In all studies, a consistent decrease of mortality after CS was observed since the nineties. 3,4,10 Previously, the AMIS (Acute Myocardial Infarction in Switzerland) Plus Registry reported the incidence and mortality of CS in Switzerland during the period between 1997 and 2006. 11 Since 2006, several trials have been published that changed treatment strategies and management of CS.…”