Temporal trends in incidence and patient characteristics in cardiogenic shock following acute myocardial infarction from 2010 to 2017: a Danish cohort study

Abstract

Aim We sought to describe the contemporary annual incidence of cardiogenic shock (CS) following acute myocardial infarction (AMICS), the proportion of patients developing CS following ST‐elevation myocardial infarction (STEMI), and other temporal changes in AMICS in Denmark between 2010 and 2017. Methods and results Medical records of patients suspected of having AMICS during 2010–2017 were reviewed to identify consecutive patients with AMICS in a cohort corresponding to two‐thirds of the Danish population. Due to changes in recruitment area over the study period, population‐based incidence could only be calculated from 2012 to 2017. A total of 1716 patients with AMICS were identified and an increase in the annual incidence was observed, from a nadir 65.3 per million person‐years in 2013 to 80.0 per million person‐years in 2017 (P‐value for trend < 0.001). This trend corresponded to an increase in patients with non‐STEMI and a decrease in patients developing CS after STEMI (10.0–6.6%, P‐value for trend < 0.001) Also, mean arterial blood pressure at the time of AMICS was lower (63 ± 11 mmHg to 61 ± 13 mmHg, P‐value for trend = 0.001) and the frequency of patients with left ventricular ejection fraction ≤ 30% increased (61.8%–71.4%, P‐value for trend = 0.004). The annual 30‐day mortality during the study period remained unchanged at about 50%. Conclusion The incidence rate of AMICS increased in the Danish population between 2012 and 2017. Fewer patients with STEMI developed CS, and haemodynamic severity of CS increased during the study period; however, survival rates remained unchanged.

Mechanical respiratory support in cardiogenic shock: reply

“…Drs. Miller, Gimenez, and Thiele raise some interesting and important perspectives to our paper and we agree that aspects of mechanical ventilation deserve more attention . Although mortality remained at ∼50% from 2010–2017 in our study, we would like to stress that the patient population changed over time with more patients admitted following out‐of‐hospital cardiac arrest (OHCA), as well as haemodynamics were more jeopardized in the recent years .…”

“…Miller, Gimenez, and Thiele raise some interesting and important perspectives to our paper and we agree that aspects of mechanical ventilation deserve more attention . Although mortality remained at ∼50% from 2010–2017 in our study, we would like to stress that the patient population changed over time with more patients admitted following out‐of‐hospital cardiac arrest (OHCA), as well as haemodynamics were more jeopardized in the recent years . The increasing use of mechanical ventilation could be related to the increasing proportion of patients presenting with OHCA, since nearly all OHCA patients received mechanical ventilation and were intubated before arrival to the centre, to protect the airway.…”

November 2019 at a glance. Chronic and acute heart failure: from epidemiology to treatment

“…An increase in non‐ST‐elevation myocardial infarction and LV dysfunction and a decrease in ST‐elevation myocardial infarction presentation were noted. Annual 30‐day mortality remained unchanged …”

Mechanical respiratory support in cardiogenic shock

“…Although advances are likely to include multiple interventions, one crucial but poorly researched aspect of the care of patients with cardiogenic shock is the management of respiratory support. In their study, Helgestad et al . noted an increase in the use of mechanical ventilation over the study period with over 85% of patients requiring ventilatory support by 2017.…”

“…We read with interest the well written and thorough study by Helgestad et al . describing temporal trends and the characteristics of acute myocardial infarction complicated by cardiogenic shock based on data from the Danish Heart Failure Registry.…”