Trends in cardiogenic shock complicating acute myocardial infarction

Abstract

Aims Few studies describe recent changes in the prevalence, management, and outcomes of cardiogenic shock (CS) patients complicating acute myocardial infarction (AMI) in the era of widespread use of invasive strategies. The aim of the present study was to analyse trends observed in CS complicating AMI over the past 10 years, focusing on the timing of CS occurrence (i.e. primary CS, CS on admission vs. secondary CS, CS developed subsequently during hospitalization). Methods and results Three nationwide French registries conducted and designed to evaluate AMI management and outcomes in ‘real‐life’ practice included consecutive AMI patients (n = 9951) admitted to intensive cardiovascular care units (ICCUs) over a 1‐month period, 5 years apart. The prevalence of CS complicating AMI decreased from 2005 to 2015: 5.9%, mean age 74.1 ± 12.7 in 2005; 4.0%, mean age 73.9 ± 12.7 in 2010, 2.8%, mean age 71.1 ± 15.0 in 2015 (P < 0.001). It decreased for both primary (1.8% to 1.0%) and secondary CS (4.1% to 1.8%). The profile of CS patients also changed over time with more patients presenting out‐of‐hospital cardiac arrest. In both primary and secondary CS, the use of percutaneous coronary intervention increased markedly over time, as did the use of mechanical ventilation and cardiac assist devices. Over the 10‐year period, in‐hospital mortality remained unchanged for both primary CS (41.8% to 37.8%) or secondary CS (57.3% to 58.8%). However, 1‐year mortality decreased in patients with primary CS (from 60% to 37.8%, P = 0.038), and remained unchanged in patients developing secondary CS (from 64.5% to 69.1%, P = 0.731). Conclusion Cardiogenic shock complicating AMI has become less frequent but, if present, CS, and particularly secondary CS, carries a very high mortality, which has not substantially improved over the past 10 years, in spite of the more frequent use of invasive strategies.

Clinical outcomes after percutaneous coronary intervention for early versus late and very late stent thrombosis: a systematic review and meta-analysis

“…As observed in the present study, the rates of CS and IABP use at the time of presentation were higher in the EST group than in the LST/VLST group. This finding could partly explain the higher mortality in EST patients, because CS has been shown to be associated with in-hospital mortality as high as 48% and 1-year mortality as high as 58% despite aggressive treatment therapies [29].…”

April 2020 at a glance: epidemiology, prevention, and biomarkers

“…The prevalence of cardiogenic shock after acute myocardial infarction decreased from 2005 (5.9%) to 2015 (2.8%), whilst the use of invasive management increased over time. In‐hospital mortality remained unchanged …”

Composite trends of cardiogenic shock complicating acute myocardial infarction

“…Therefore, in order to further reduce the trend in CS complicating AMI, it seems crucial to implement emergency networks and protocols for early recognizing ‘pre‐shock’ conditions, during which a potentially reversible haemodynamic state exists and for reducing delays in reperfusion, especially in patients with OHCA at increased risk for developing CS. In this regard, in the analysis published in this issue of the Journal, some baseline characteristics such as older age, OHCA, and ST‐elevation myocardial infarction were associated with both primary and secondary CS, while higher C‐reactive protein levels, left bundle branch block or right bundle branch block on admission were specifically associated with secondary CS. These findings might be used to better identify patients at high risk of developing CS during hospitalization following AMI, facilitating prompt clinical decision making.…”

“…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 . 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 . 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.…”