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Cardiogenic shock complicating acute myocardial infarction; prognostic impact of early and late shock development
M G Lindholm1, L Køber, S Boesgaard
1Medical Department B 2142, Division of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK 2100, Copenhagen, Denmark.
Insights
Cardiogenic shock significantly increases mortality after myocardial infarction. Early detection and improved treatments are crucial for patients experiencing shock, as it drastically reduces life expectancy.
Area of Science:
- Cardiology
- Clinical Medicine
- Public Health
Background:
- Cardiogenic shock is a major cause of mortality post-acute myocardial infarction.
- Existing outcome data often comes from limited, selected patient populations.
- There is a need for comprehensive data on cardiogenic shock in real-world settings.
Purpose of the Study:
- To determine the incidence of cardiogenic shock in a large, consecutive cohort of acute myocardial infarction patients.
- To investigate the outcomes and prognostic significance of cardiogenic shock.
- To analyze the timing of cardiogenic shock development in relation to myocardial infarction.
Main Methods:
- Prospective data collection from 6676 consecutive patients with myocardial infarction across 27 hospitals.
- Inclusion of demographic and clinical data, including the presence of cardiogenic shock.
- Six-year mortality data collected for 99.9% of the study population.
Main Results:
- Cardiogenic shock occurred in 6.7% of patients (444 individuals).
- Thirty-day and 6-year mortality rates were 62% and 88% for shock patients, versus 9% and 45% for non-shock patients.
- Early shock development (days 1-2) was associated with lower 30-day mortality (45%) compared to later onset.
Conclusions:
- Cardiogenic shock in non-invasively managed myocardial infarction patients is associated with extremely poor life expectancy.
- Enhanced efforts in prevention, early identification of at-risk patients, and improved treatment strategies are urgently needed.
- Even survivors of cardiogenic shock face reduced long-term survival compared to those without shock but with heart failure.
Aims:
Cardiogenic shock accounts for the majority of deaths following acute myocardial infarction. The majority of outcome data on this issue are, however, derived from single hospitals, referral centers or selected patients in randomized studies. The purpose of this study was to investigate incidence, outcome and prognostic significance of cardiogenic shock in 6676 consecutive patients with acute myocardial infarction.
Methods And Results:
Demographic and clinical data including the presence of cardiogenic shock were prospectively collected in 6676 non-invasively managed patients with myocardial infarction consecutively admitted to 27 different hospitals during a 2-year period. Six-year mortality data were collected in 99.9% of the population. Cardiogenic shock developed in 444 patients (6.7%). In 59% of these patients cardiogenic shock developed within 48 h, 11% developed shock during days 3 and 4 and 30% later than 4 days after the infarction. Thirty-day and 6-year mortality was 62 and 88% among shock patients compared to 9 and 45% in non-shock patients. Patients with early shock development (days 1-2) had a significantly lower 30-day mortality (45%) than those with intermediate or late shock development (>80%) (P<0.05). In 30-day survivors, survival the following years was lower than in patients without cardiogenic shock but with post-infarction heart failure.
Conclusions:
In this nationwide prospectively collected registry, non-invasively managed consecutive myocardial infarct patients with cardiogenic shock had an extremely reduced life expectancy. Every attempt to improve treatment, prevention and identification of patients at risk of shock development should be strongly encouraged.
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