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(Circulation. 2009;119:1211-1219.)
© 2009 American Heart Association, Inc.

Epidemiology

Thirty-Year Trends (1975 to 2005) in the Magnitude of, Management of, and Hospital Death Rates Associated With Cardiogenic Shock in Patients With Acute Myocardial Infarction

A Population-Based Perspective

Robert J. Goldberg, PhD; Frederick A. Spencer, MD; Joel M. Gore, MD; Darleen Lessard, MS; Jorge Yarzebski, MD, MPH

From the Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester (R.J.G., J.M.G., D.L., J.Y.), and Department of Medicine, McMaster University, Hamilton, Ontario, Canada (F.A.S.).

Reprint requests to Robert J. Goldberg, PhD, Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Ave N, Worcester, MA 01655. E-mail Robert.Goldberg{at}umassmed.edu

Received August 14, 2008; accepted December 31, 2008.

Background— Limited information is available about potentially changing and contemporary trends in the incidence and hospital death rates of cardiogenic shock complicating acute myocardial infarction. The objectives of our study were to examine 3-decade-long trends (1975 to 2005) in the incidence rates of cardiogenic shock complicating acute myocardial infarction, patient characteristics and treatment practices associated with this clinical complication, and hospital death rates in residents of a large central New England community hospitalized with acute myocardial infarction at all area medical centers.

Methods and Results— The study population consisted of 13 663 residents of the Worcester (Mass) metropolitan area hospitalized with acute myocardial infarction at all greater Worcester medical centers during 15 annual periods between 1975 and 2005. Overall, 6.6% of patients developed cardiogenic shock during their index hospitalization. The incidence rates of cardiogenic shock remained stable between 1975 and the late 1990s but declined in an inconsistent manner thereafter. Patients in whom cardiogenic shock developed had a significantly greater risk of dying during hospitalization (65.4%) than those who did not develop cardiogenic shock (10.6%) (P<0.001). Encouraging increases in hospital survival in patients with cardiogenic shock, however, were observed from the mid-1990s to our most recent study years. Several patient demographic and clinical characteristics were associated with an increased risk for developing cardiogenic shock.

Conclusions— Our findings indicate improving trends in the hospital prognosis associated with cardiogenic shock. Given the high death rates associated with this clinical complication, monitoring future trends in the incidence and death rates and the factors associated with an increased risk for developing cardiogenic shock remains warranted.

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CLINICAL PERSPECTIVE

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Clinical Summaries
Circulation 2009 119: 1177-1179. [Extract] [Full Text]