Ten-Year Trends in the Incidence and Treatment of Cardiogenic Shock

4 November 2008 | Volume 149 Issue 9 | Pages 618-626

Background: Few studies describe recent changes in the incidence, treatment, and outcomes of cardiogenic shock.

Objective: To examine temporal trends in the incidence, therapeutic management, and mortality rates of patients with the acute coronary syndrome (ACS) and cardiogenic shock, and to assess associations of therapeutic management with death and cardiogenic shock developing during hospitalization.

Design: Analysis of registry data collected among patients admitted to hospitals between 1997 and 2006.

Setting: 70 of the 106 acute cardiac care hospitals in Switzerland.

Patients: 23696 adults with ACS enrolled in the AMIS (Acute Myocardial Infarction in Switzerland) Plus Registry.

Measurements: Cardiogenic shock incidence; treatment, including rates of percutaneous coronary intervention; and in-hospital mortality rates.

Results: Rates of overall cardiogenic shock (8.3% of patients with ACS) and cardiogenic shock developing during hospitalization (6.0% of patients with ACS and 71.5% of patients with cardiogenic shock) decreased during the past decade (P< 0.001 for temporal trend), whereas rates of cardiogenic shock on admission remained constant (2.3% of patients with ACS and 28.5% of patients with cardiogenic shock). Rates of percutaneous coronary intervention increased among patients with cardiogenic shock (7.6% to 65.9%; P= 0.010), whereas in-hospital mortality decreased (62.8% to 47.7%; P= 0.010). Percutaneous coronary intervention was independently associated with lower risk for both in-hospital mortality in all patients with ACS (odds ratio, 0.47 [95% CI, 0.30 to 0.73]; P= 0.001) and cardiogenic shock development during hospitalization in patients with ACS but without cardiogenic shock on admission (odds ratio, 0.59 [CI, 0.39 to 0.89]; P= 0.012).

Limitations: 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.

Conclusion: Over the past decade, rates of cardiogenic shock developing during hospitalization and in-hospital mortality decreased among patients with ACS. Increased percutaneous coronary intervention rates were associated with decreased mortality among patients with cardiogenic shock and with decreased development of cardiogenic shock during hospitalization.

Editors' Notes Context Are the incidence and management of cardiogenic shock changing? Contribution This analysis of hospital registry data from Switzerland showed that rates of cardiogenic shock in patients with acute coronary syndromes declined from 1997 to 2006. Declining rates were due to decreased rates of shock development during hospitalization rather than a change in rates of shock at admission. Use of percutaneous coronary intervention increased, and in-hospital mortality decreased. Implication 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 acute coronary syndromes. The Editors

 

Author and Article Information

From University Hospital Basel, Basel; University of Zurich, Zurich; University Hospital Lausanne, Lausanne; Cantonal Hospital Lucerne, Lucerne; and La Tour Hospital, Geneva, Switzerland.

Grant Support: The AMIS Plus Registry project was supported by the following sources (all in Switzerland; grouped by city rather than by grant size or any other preferential factor): Swiss Heart Foundation and Novartis Pharma Schweiz, Bern; A. Menarini, Bayer (Schweiz), Pfizer, SPSS (Schweiz), and St. Jude Medical, Zurich; AstraZeneca, Zug; Biotronik Schweiz, Bristol-Myers Squibb, and Schering, Baar; Boehringer Ingelheim (Schweiz), Basel; Boston Scientific, Solothurn; Cordis, Johnson & Johnson, Spreitenbach; GlaxoSmithKline, Mnchenbuchsee; Invatec, Schaffhausen; Medtronic Schweiz, Tolochenaz; MCM medsys, Kirchberg; Merck Sharp & Dohme Chibret, Opfikon-Glattbrugg; Nycomed Pharma, Dbendorf; Sanofi-Aventis (Suisse) and Servier (Suisse), Meyrin; and Takeda Pharma, Lachen, Switzerland.

Potential Financial Conflicts of Interest: None disclosed.

Reproducible Research Statement: Study protocol: Case report form available at http://www.amis-plus.ch. Statistical code: Available from Dr. Radovanovic (e-mail, dragana{at}ifspm.uzh.ch). Data set: Not available.

Requests for Single Reprints: Philip Urban, MD, Cardiovascular Department, La Tour Hospital, Avenue Maillard 1, 1217 Meyrin-Geneva, Switzerland; e-mail, philip.urban{at}latour.ch.

Current Author Addresses: Drs. Jeger and Pfisterer: Cardiology, University Hospital, Petersgraben 4, CH-4031 Basel, Switzerland.

Dr. Radovanovic: AMIS Plus Data Center, Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, CH-8001 Zurich, Switzerland.

Dr. Hunziker: Medical Intensive Care Unit, University Hospital, Petersgraben 4, CH-4031 Basel, Switzerland.

Dr. Stauffer: Cardiology, University Hospital, Rue du Bugnon 46, CH-1101 Lausanne, Switzerland.

Dr. Erne: Cardiology, Cantonal Hospital, CH-6000 Lucerne 16, Switzerland.

Dr. Urban: Cardiovascular Department, La Tour Hospital, Avenue Maillard 1, 1217 Meyrin-Geneva, Switzerland.

Author Contributions: Conception and design: R.V. Jeger, P.R. Hunziker.

Analysis and interpretation of the data: R.V. Jeger, D. Radovanovic, M.E. Pfisterer, J.C. Stauffer.

Drafting of the article: R.V. Jeger, P.R. Hunziker.

Critical revision of the article for important intellectual content: D. Radovanovic, P.R. Hunziker, M.E. Pfisterer, J.C. Stauffer.

Final approval of the article: R.V. Jeger, D. Radovanovic, P.R. Hunziker, M.E. Pfisterer, J.C. Stauffer.

Provision of study materials or patients: P.R. Hunziker, J.C. Stauffer.

Statistical expertise: R.V. Jeger.

Administrative, technical, or logistic support: R.V. Jeger, P.R. Hunziker.

Collection and assembly of data: P.R. Hunziker.