Temporal trends in the epidemiology, management, and outcome of patients with cardiogenic shock complicating acute coronary syndromes

Abstract

Aims Despite advances in the management of patients with acute coronary syndrome (ACS), cardiogenic shock (CS) remains the leading cause of death in these patients. We describe the evolution of clinical characteristics, in‐hospital management, and outcome of patients with CS complicating ACS. Methods and results We analysed data from five Italian nationwide prospective registries, conducted between 2001 and 2014, including consecutive patients with ACS. Out of 28 217 ACS patients enrolled, 1209 (4.3%) had CS: 526 (44%) at the time of admission and 683 (56%) later on during hospitalization. Over the years, a reduction in the incidence of CS was observed, even though this was not statistically significant (P for trend = 0.17). The proportions of CS patients with a history of heart failure declined, whereas the proportion of those with hypertension, renal dysfunction, previous PCI, and AF significantly increased. The use of PCI considerably increased from 2001 to 2014 [19% to 60%; percentage change 41, 95% confidence interval (CI) 29–51]. In‐hospital mortality of CS patients decreased from 68% (95% CI 59–76) in 2001 to 38% (95% CI 29–47) in 2014 (percentage change −30, 95% CI −41 to −18). Compared with 2001, the risk of death was significantly lower in all of the registries, with reductions in adjusted mortality between 45% and 66%. Conclusions Over the last 14 years, substantial changes occurred in the clinical characteristics and management of patients with CS complicating ACS, with a greater use of PCI and a significant reduction in adjusted mortality rate.

Invasive Treatment in Advanced (Stage-D) Heart Failure

“…Percutaneous coronary intervention via balloon angioplasty associated with or without stent implantation is the first-stage therapy for coronary artery disease causing severe cardiac decompensation due to massive ischemia in high-risk patients with well-known compensated HF associated with or without mechanical complications of myocardial infarction, particularly MR. Coronary revascularization could aid in recovery of myocardial dysfunction if the affected myocardium consists of viable tissue, and MR may also be improved. Myocardial reserve after angioplasty also results in contractile improvement and favorable left ventricular remodeling in patients with LVD, and it also decreases HF symptoms (angina, functional class, BNP levels) [16,17]. Partially or fully viability or transmural scar within the infarct should be identified by any test (scintigraphy, magnetic resonance, etc.)…”

Trends in the management and outcomes of patients admitted with acute coronary syndrome complicated by cardiogenic shock over the past decade: Real world data from the acute coronary syndrome Israeli survey (ACSIS)

“…The mortality from CS remains high, in spite of a decline in overall mortality and advances in medical management of patients presenting with ACS [1–5]. …”

An Epidemiological Study of Cardiovascular Risk Factors in Patients with Myocardial Infarction: A Prospective Study

“…In 2013, the rate of prevalence of cardiovascular diseases was about 71.3 million (34.2%) in the United States (7). Coroner vessel diseases had the first rank and these kinds of diseases were the most common causes of death in both developed and developing countries (8,9).…”

“…American researchers of the Heart Association showed that about 13.2 million patients (6.9% of the whole American population) had heart coroner vessel diseases in 2013. The rate of death was about 479300 people, where 53% of the total deaths had occurred in the United States (7). Researchers also showed that the rate of survival after confinement was very low (10).…”