17-year trends in incidence and prognosis of cardiogenic shock in patients with acute myocardial infarction in western Sweden☆
Introduction
Cardiogenic shock remains the leading cause of in hospital death in acute myocardial infarction and is associated with a mortality rate of approximately 50% [1]. Cardiogenic shock may lead to death from hemodynamic deterioration per se or from target organ hypoperfusion with subsequent development of multiorgan dysfunction and/or overt systemic inflammatory syndrome [2], [3]. The incidence of cardiogenic shock in acute myocardial infarction (AMI) has declined in recent decades [4], [5], [6], [7]. This declining trend has been ascribed to early reperfusion strategies, including percutaneous coronary intervention (PCI). Recently, however, a report from an American cohort detected no difference in incidence of cardiogenic shock over the past three decades. If anything, the authors observed a trend towards increasing incidence of cardiogenic shock [8].
PCI, if performed within 90 min after symptom onset, improves prognosis in patients with ST-elevation myocardial infarction (STEMI) and reduces the risk of post-infarct heart failure and cardiogenic shock compared with thrombolysis [9]. International guidelines therefore advocate primary PCI as first-line treatment in patients presenting with STEMI [10], [11].
Sweden has a national system of medical and healthcare quality registries, which contain individualized data concerning diagnoses, interventions and outcome. In the present manuscript, we present the trends in incidence and prognosis of AMI-induced cardiogenic shock from 1995 to 2013 in Västra Götaland in western Sweden, an area with approximately 1.6 million inhabitants who are served by five hospitals. This study period includes the transition from thrombolysis to primary PCI as the region-wide therapy of choice for patients with STEMI.
Section snippets
Methods
The study was approved by the ethics committee of Gothenburg University and adheres to the ethics of scientific publication.
Patient characteristics and treatments
During the study period, 44,414 patients were treated due to AMI in cardiac care units in western Sweden. 3,654 of these patients developed cardiogenic shock (36% women) (Fig. 1). Patient characteristics are presented in Table 1. Patients who developed cardiogenic shock were older and more likely to be women and have diabetes mellitus. They were also more likely to previously have had an AMI and to present with STEMI. On the other hand, patients with cardiogenic shock were less likely to have
Discussion
We investigated the trends in incidence of cardiogenic shock and its impact on mortality in 44,414 patients, 3654 of whom developed cardiogenic shock, in the prospective SWEDHEART database for western Sweden. We found that the incidence of cardiogenic shock declined by 71% over the last seventeen years. The declining incidence of cardiogenic shock was accompanied by a 54% reduction in the overall short-term risk of death for patients with AMI. The steepest decline coincided with the change from
Conclusion
In conclusion, our study demonstrates that the incidence of AMI-induced cardiogenic shock has declined in western Sweden over the past decade. However, once cardiogenic shock develops the mortality is higher today than it was in 1995.
Conflicts of interest
None.
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