乌鸦传媒

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Heart attack patients are more likely to die or return to the hospital in the first 60 days after discharge if they had cardiogenic shock but the difference fades thereafter, a national registry showed.

And, another population-based study suggested that in-hospital mortality with cardiogenic shock has been declining.

In the first study, at 60 days compared with 24.9% of myocardial infarction (MI) patients who didn't go into shock (adjusted hazard ratio 1.28, 95% confidence interval 1.21-1.35), , of the University of Utah in Salt Lake City, and colleagues found.

But at 1 year, rates were similar for the shock and nonshock groups at 59.1% and 52.3%, respectively, which was not statistically significant after adjustment for patient and hospital characteristics, they reported in the Feb. 23 issue of the Journal of the American College of Cardiology.

Post-Discharge Outcomes

The data came from Medicare-linked records on 112,668 acute MI survivors treated at 677 U.S. hospitals from January 2007 through September 2012 in the National Cardiovascular Data Registry's ACTION Registry-Get With the Guidelines database. Among them, 5% percent experienced cardiogenic shock during the initial hospitalization.

Shah's group concluded with a call to determine why patients appear so vulnerable in the immediate post-hospital period.

"This information would be valuable for tailoring interventions to improve early survival and for identifying the sickest patients who may be better served with palliative care or hospice," they wrote.

Given that "surprisingly few hospitalizations (less than one-quarter) were attributed to heart failure," patient comorbidities are increasingly important, , of Technische Universität München in Munich, and colleagues suggested in an accompanying editorial.

"These findings should prompt us to focus more on optimization of treatment of noncardiac conditions during the in-hospital and early discharge periods in patients with AMI complicated by cardiogenic shock," they wrote, adding that "measures that warrant further investigation in these patients include the optimal revascularization strategy in multivessel coronary artery disease and the optimal mechanical therapy for reversal of cardiogenic shock."

In-Hospital Outcomes

Incidence of cardiogenic shock among acute MI patients has stayed steady while mortality from it has declined over the past decade, a separate population-based study showed.

An average 3.7% of acute MI patients developed cardiogenic shock during their hospitalization over the period from 2001 to 2011, up or down in crude or multivariable-adjusted analyses, , of the University of Massachusetts Medical School in Worcester, and colleagues reported online in Circulation: Cardiovascular Quality and Outcomes.

But the in-hospital case-fatality rate declined from 47.1% in 2001/2003 down to 28.6% in 2009/2011, a difference that persisted in multivariable adjusted analysis.

"Increases in the use of evidence-based cardiac medications, and interventional procedures paralleled the increasing hospital survival trends," the researchers noted.

Their study included 5,686 acute MI patients living in central Massachusetts hospitalized at one of the 11 medical centers in the region during six biennial periods between 2001 and 2011 who did not have cardiogenic shock upon presentation.

"Despite encouraging declines in the death rates associated with cardiogenic shock in patients hospitalized with AMI," they concluded, "cardiogenic shock continues to be a serious complication of AMI with a high death rate but one that is potentially preventable and treatable with early and aggressive identification of high-risk patients and effective medical management."