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)

Abstract

Registries and other cohorts have demonstrated that early revascularization improve the survival of patients presenting with Cardiogenic Shock (CS) completing Aute coronary syndrome (ACS). Our aim was to describe the change in the clinical characteristics of these patients and their management and their outcome. The study population comprised 224 patients who were admitted with ACS complicated by cardiogenic shock who were enrolled in the prospective biannual Acute Coronary Syndrome Israeli Surveys (ACSIS) between 2000 and 2013 (1.7% of all patients admitted with ACS during the study period). Survey periods were categorized as early (years 2000-2004) and late (year 2006-2013).The rate of cardiogenic shock complicated ACS declined from 1.8% between the years 2000-2004 to 1.5% during the years 2006-2013. The clinical presentation in both the early and late groups was similar. During the index hospitalization primary percutaneous coronary intervention (PPCI) was more frequently employed during the late surveys [31% vs. 58% (p<0.001)], while fibrinolysis therapy was not used in the late surveys group [27% vs. 0.0% (p=<0.001)]. Compared to patients enrolled in the early surveys, those enrolled in the late survey group experienced significantly lower mortality rates at 7-days (44% vs. 30%, respectively; p=0.03). However, this difference was no longer statistically significant at 30-days (52.8% vs. 46.4%, respectively, p=0.34) and 1-year (63% vs. 53.2%, respectively, p=0.14). Similarly, the rate of major adverse cardiac events (MACE) at 30-days was similar between the two groups (57.4% vs. 47.4%, respectively, p=0.13).Our findings indicate that patients admitted with ACS complicated by cardiogenic shock still experience very high rates of MACE and mortality during follow-up, despite a significant increase in the use of PPCI in this population over the past decade.

The changing face of cardiogenic shock complicating acute myocardial infarction

“…Overall, the trends in incidence, revascularization, and mortality of AMICS in Denmark mimic those seen in most other countries across the world ( Table ) . One of the important findings of the study by Helgestad et al .…”

“…Cardiogenic shock (CS) complicates 5% to 10% of cases with acute myocardial infarction (AMI) and remains the leading cause of death in patients with AMI . The Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial demonstrated improved short‐ and long‐term survival with early revascularization in patients with AMI and CS (AMICS) .…”

“…The Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial demonstrated improved short‐ and long‐term survival with early revascularization in patients with AMI and CS (AMICS) . Although rates of early coronary angiography in patients with AMICS have increased over the past two decades, only 60% to 70% of patients undergo early revascularization . Further, in AMICS patients undergoing early revascularization, the use of intra‐aortic balloon pump (IABP) failed to demonstrate reduction in 30‐day mortality in the IABP‐SHOCK II trial .…”

“…Although there is some evidence suggesting improved outcomes with the use of other mechanical circulatory support (MCS) devices such as Impella (Abiomed, Danvers, MA, USA), especially when used before percutaneous coronary intervention (PCI), randomized clinical trial data are lacking . In‐hospital mortality rates in patients with AMICS, therefore, continue to remain high at 40% to 50% …”

“…Cardiogenic shock (CS) complicates 5% to 10% of cases with acute myocardial infarction (AMI) and remains the leading cause of death in patients with AMI. [1][2][3][4][5][6][7][8][9][10] The Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial demonstrated improved short-and long-term survival with early revascularization in patients with AMI and CS (AMICS). 11 Although rates of early coronary angiography in patients with AMICS have increased over the past two decades, only 60% to 70% of patients undergo early revascularization.…”