AIM: Patient management can lead to decreased deaths from cardiogenic shock

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Over the past decade, the rates of cardiogenic shock developing during hospitalization and in-hospital mortality decreased among patients with acute coronary syndrome, in part due to increased PCI rates, according to a study in the Nov. 4 issue of the Annals of Internal Medicine.

Raban V. Jeger, MD, from the University Hospital Basel in Basel, Switzerland, and colleagues examined the temporal trends in the incidence, therapeutic management and mortality rates of patients with the ACS and cardiogenic shock, and assessed associations of therapeutic management with death and cardiogenic shock developing during hospitalization.

The researchers collected registry data among patients admitted to hospitals between 1997 and 2006 in 70 of the 106 acute cardiac care hospitals in Switzerland. They examined 23,696 adults with ACS, enrolled in the AMIS (Acute MI in Switzerland) plus the registry.

The investigators found that the rates of overall cardiogenic shock (8.3 percent of patients with ACS) and cardiogenic shock developing during hospitalization (6 percent of patients with ACS and 71.5 percent of patients with cardiogenic shock) decreased during the past decade, whereas rates of cardiogenic shock on admission remained constant (2.3 percent of patients with ACS and 28.5 percent of patients with cardiogenic shock).

According to authors, rates of PCI increased among patients with cardiogenic shock (7.6 to 65.9 percent), whereas in-hospital mortality decreased (62.8 to 47.7 percent). PCI was independently associated with lower risk for both in-hospital mortality in all patients with ACS (odds ratio, 0.47) and cardiogenic shock development during hospitalization in patients with ACS, but without cardiogenic shock on admission (odds ratio, 0.59).

In terms of the study’s limitations, Jeger and colleagues acknowledged that there was no central review of cardiogenic shock diagnoses and follow-up duration was confined to the hospital stay. Unmeasured or inaccurately measured characteristics may have confounded observed associations of treatment with outcomes.

The researchers concluded that the incidence and mortality of cardiogenic shock in hospitalized patients in Switzerland decreased during the past decade, possibly because of changes in management of patients with ACS.