Abstract 14913: Declining Incidence and Improved Outcome of Cardiogenic Shock at the Acute Stage of MI. A Report from the USIK 1995, USIC 2000 and FAST-MI French Nationwide Registries
Background: There is conflicting evidence on the evolution of incidence and outcome of cardiogenic shock (CS) in AMI patients over the past decade. Aim: to compare 30-day death in AMI patients from 1995 to 2005, according to presence of CS.
Methods: USIK, USIC 2000 and FAST-MI are 3 nationwide French registries conducted 5 years apart, using a similar methodology in consecutive pts admitted to CCUs over a one-month period. All 7531 AMI pts presenting ≤48 hrs of symptom onset were included. Evolution of mortality was compared in the 486 pts with CS vs those without CS.
Results: Incidence of CS tended to decrease over this period of time (6.9% in 1995; 5.7% in 2005, P = 0.07). CS was more frequent in pts with STEMI vs NSTEMI (6.9% v 5.5%, P=0.02). Pts with CS were older than those without (74 ± 12 vs 66 ± 14 years, p<0.001); mean age of CS pts remained unchanged (74 ±12 in 1995, 74 ± 13 years in 2005). Thirty-day mortality was considerably higher in CS pts (60.9% vs 5.2%). Over the 10-year period, mortality decreased for both pts with (70% to 51%, P=0.003) and without CS (9% to 4%, P<0.001). In CS pts, use of PCI increased from 20% in 1995 to 50% in 2005 (P<0.001), and in STEMI patients with CS, reperfusion therapy increased from 40% in 1995 to 63% in 2005. Use of recommended medications during hospitalisation also increased (antiplatelet agents: 71% to 87%, ACE-I: 31% to 38%, statins: 4% to 55%). Using multivariate analysis in the whole population, both time period and presence of CS were independent predictors of 30-day mortality. In CS pts, time period was an independent predictor of mortality (OR for death, 2005 vs 1995= 0.43; 95% CI: 0.26–0.71, P=0.005), along with age, diabetes and smoking status. When use of PCI was added to the multivariate model, however, PCI was associated with decreased mortality (OR=0.35; 95%CI: 0.23–0.54, P<0.001) and time period was no longer significant.
Conclusions: In these 3 nationwide surveys conducted 10 years apart, the incidence of CS tended to decrease and early mortality of CS patients significantly decreased. Multivariate analysis showed that the improved outcome in CS patients could be explained by a broader use of PCI at the acute stage over this period of time. These data confirm the importance of early revascularization in patients with cardiogenic shock.
- © 2010 by American Heart Association, Inc.