Temporal Trends in Cardiogenic Shock Complicating Acute Myocardial Infarction in South Korea
Pil Sang Song1, Kye Taek Ahn2, Mi Joo Kim2
1Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea. pssong73@gmail.com.
Insights
Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) decreased over a decade, with improved survival for pre-admission CS. However, in-hospital CS survival did not improve, highlighting the need for better prevention and treatment strategies.
Area of Science:
- Cardiology
- Clinical Research
- Public Health
Background:
- Cardiogenic shock (CS) is a severe complication of acute myocardial infarction (AMI).
- Understanding temporal trends and predictors of CS is crucial for improving patient outcomes.
- Previous studies have varied in their focus on CS development and mortality.
Purpose of the Study:
- To investigate temporal trends in the prevalence of cardiogenic shock complicating AMI.
- To identify predictors of CS development during hospitalization.
- To assess predictors of mortality in patients with CS following AMI.
Main Methods:
- Utilized data from two Korean AMI Registries (KAMIR-NIH and KAMIR-V) spanning 2011-2020.
- Categorized CS into CS before admission (ba-CS) and CS developing during admission (da-CS).
- Analyzed temporal trends by dividing the study period into early (2011-2015) and late (2016-2020) phases.
Main Results:
- Overall CS prevalence decreased from 12.5% to 9.6% (p<0.001), with reductions in both ba-CS and da-CS.
- Percutaneous coronary intervention use increased significantly over the study period.
- In-hospital mortality decreased for overall CS (27.3% to 22.9%) and ba-CS (25.1% to 17.0%), but not for da-CS (30.3% to 32.9%).
Conclusions:
- While overall and pre-admission CS mortality has declined, the lack of improvement in in-hospital CS mortality necessitates enhanced prevention strategies.
- Early identification of CS development post-admission is critical.
- Alternative therapeutic strategies are needed for high-risk patients developing CS during the acute phase of AMI.
Background And Objectives:
We aimed to study temporal trends in cardiogenic shock (CS) complicating acute myocardial infarction (AMI) and assessed the predictors of shock development during hospitalization and of mortality.
Methods:
Data were obtained from 2 Korean AMI Registries (KAMIRs), the KAMIR-National Institutes of Health (early) and KAMIR-V (late). Patients with CS were those with CS before admission (ba-CS) and those who developed CS during admission as a complication of AMI (da-CS). Temporal trends were examined as early (2011-2015) and late (2016-2020) periods.
Results:
A total of 28,990 patients was included, of whom 3,179 (11.0%) had CS. The overall prevalence of CS decreased from 12.5% to 9.6% (p for trend <0.001). Among CS patients, 1,900 (59.8% of those with CS) had ba-CS and 1,279 developed da-CS. The prevalence of both ba- (7.1% to 6.1%, p<0.001) and da-CS (5.4% to 3.6%, p<0.001) decreased, while the use of percutaneous coronary intervention increased. Over the 10-year period, in-hospital mortality rates decreased in overall CS (from 27.3% to 22.9%; p=0.004) and ba-CS (from 25.1% to 17.0%; p<0.001), but not in da-CS (from 30.3% to 32.9%; p=0.335).
Conclusions:
The decline in mortality rates of overall and ba-CS but not that of da-CS emphasizes the need for enhanced prevention strategies, early identification of development of CS after admission, and alternative therapeutic strategies for patients at high risk of CS in the acute stage of AMI.
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