Temporal Trends in Cardiogenic Shock Complicating Acute Myocardial Infarction

Goldberg, Robert J.; Samad, Navid A.; Yarzebski, Jorge L.; Gurwitz, Jerry H.; Bigelow, Carol; Gore, Joel M.

doi:10.1056/nejm199904153401504

Cited by 538 publications

(295 citation statements)

References 37 publications

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“…The remaining cases correspond to mechanical defects, such as rupture of the ventricular septum or the papillary muscle, or right ventricular infarction 32,33 . Recent estimates point to an incidence of approximately 7% of cardiogenic shock in patients with acute myocardial infarction, 10% of whom have this condition on hospital admission, while the remaining 90% develop that complication during hospitalization 34 . The same authors showed a drop in the early mortality rate from 70%-80% in the 1970s to 50%-60% in the 1990s in the group of patients with this condition associated with acute myocardial infarction.…”

Section: Discussionmentioning

confidence: 99%

Predictive factors of in-hospital mortality and of severe perioperative complications in myocardial revascularization surgery

Almeida¹,

Barreto²,

Couto³

et al. 2003

Arq. Bras. Cardiol.

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At the beginning of the 20 th century, cardiovascular diseases accounted for less than 10% of the deaths in the world. At the end of that century, that group of diseases accounted for approximately half of the deaths in the developed countries and 25% of the deaths in developing countries. In 2020, cardiovascular diseases are estimated to ount for 25 million deaths per year, and ischemic heart diseases will surpass infectious diseases as the first cause of death in the world 1 .In Brazil, cardiovascular diseases lead the causes of death and hospitalization, accounting for 32.6% of the deaths with a determined cause. From 1996 to 1999, cardiovascular diseases accounted for 9% of the hospitalizations via SUS (Sistema Único de Saúde -the Brazilian public health system), being the major cause of hospitalization in the population aged 40 to 59 years (17%) and in the population aged 60 or above (29%). Ischemic cardiac diseases accounted for 29.6% of the deaths due to cardiovascular diseases, the mean mortality rate of this group of diseases being 46.4 deaths per 100,000 inhabitants/year in the period 2 .Mortality due to ischemic heart diseases varies widely among countries and among regions in the same country. Recent data from the MONICA Project 3 relative to a 10-year period of study with 37 different populations indicate a reduction in ischemic cardiac events and related mortality rates in most countries. Multiple aspects have contributed to this favorable tendency, including the reduction in the prevalence of risk factors, the improvement in health care and the increase in access to it, and new methods of diagnosis and treatment 4,5 .The number of myocardial revascularization surgeries increased 227% in the United States from 1979States from to 1997States from , and, in 1997,000 patients underwent this surgical procedure. In that country, approximately 1 in every 1,000 individuals undergoes myocardial revascularization surgery per year, which results in costs of $ 50 billion an-

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Section: Discussionmentioning

confidence: 99%

Predictive factors of in-hospital mortality and of severe perioperative complications in myocardial revascularization surgery

Almeida¹,

Barreto²,

Couto³

et al. 2003

Arq. Bras. Cardiol.

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“…[1][2][3][4] Although predictors of cardiogenic shock have been determined, 5 there are limited data on early markers of outcome in this disease. Although echocardiographic evaluation is widely used in MI, assessing its value acutely in cardiogenic shock has been more challenging, and thus it has not been established whether specific features of cardiac structure or function early in the course of cardiogenic shock provide prognostic value.…”

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Echocardiographic Predictors of Survival and Response to Early Revascularization in Cardiogenic Shock

et al. 2003

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for the SHOCK Trial Background-Although echocardiography is used in diagnosis and management of myocardial infarction, it has not been established whether specific features of cardiac structure or function early in the course of cardiogenic shock provide prognostic value. The purposes of this substudy of the SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK (SHOCK) trial were to describe the echocardiographic features of cardiogenic shock, identify findings on early echocardiograms associated with outcome, examine the interaction of such features with treatment, and determine whether these features could provide insights into the survival benefit observed with early revascularization and guide selection of patients for this strategy. Methods and Results-One hundred seventy-five echocardiograms performed within 24 hours of randomization to the early revascularization (ERV) or initial medical stabilization (IMS) arms of the trial were submitted for quantitative assessment, and 169 were suitable for analysis. The 2 groups were similar in terms of clinical and early echocardiographic characteristics. Mean left ventricular ejection fraction (LVEF) was 31%, and moderate or greater mitral regurgitation (MR) was noted in 39.1%. On multivariate analysis, the only independent predictors of survival were MR severity and LVEF. A survival benefit for the ERV strategy was observed at all levels of LVEF and MR. Conclusions-A wide range of cardiac structural and functional abnormalities exists in patients presenting with acute cardiogenic shock. Both short-and long-term mortality appear to be associated with initial left ventricular systolic function and MR as assessed by echocardiography, and a benefit of ERV is noted regardless of baseline LVEF or MR.

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“…5 However, with advances in coronary reperfusion techniques over the past few decades, especially with the introduction of primary percutaneous coronary intervention (PCI), the mortality rate has improved to below 50 %. 4,[6][7][8][9][10][11][12] The trend towards better outcomes may also be due to greater awareness of the need for timely treatment, improvements in the medical care of haemodynamically unstable patients as well as the use of mechanical support devices, although this has not yet been clearly demonstrated.Despite this high mortality rate, it is important to note that patients with cardiogenic shock who survive to discharge have a long-term outcome similar to that of patients without cardiogenic shock, with a good functional outcome at 1 year. 13,14 This highlights the importance of improving the chance of early survival among patients in cardiogenic shock.…”

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confidence: 99%

“…7,9,11,15,16 This benefit is thought to be due to increased use of coronary revascularisation strategies, which, by restoring flow to the ischaemic myocardium, can limit infarct size as well as interrupt the downward spiral that characterises cardiogenic shock. 7,9,15 As such, the cornerstone of the management of cardiogenic shock complicating acute MI is prompt revascularisation, as highlighted in …”

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Primary Angioplasty For Patients in Cardiogenic Shock: Optimal Management

Joseph¹,

Patterson²,

Arri³

et al. 2016

Interventional Cardiology Review

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CoronaryCardiogenic shock is a clinical condition of inadequate end-organ perfusion due to cardiac dysfunction (see Table 1). It most commonly occurs in the setting of acute MI with left ventricular failure (~80 % cases), 1,2 but can also be caused by right ventricular infarction or late mechanical complications, such as acute mitral regurgitation or ventricular rupture (septal or free wall). Non-infarct-related cardiogenic shock is comparatively rare, and may result from decompensated valvular heart disease and arrhythmias, to name a few mechanisms.The pathophysiology of cardiogenic shock is complex. Myocardial ischaemia induces marked depression of myocardial contractility, this sets into motion a downward spiral of reduced cardiac output and hypotension, which in turn drives further myocardial ischaemia. Incidence and Prognosis of Cardiogenic ShockCardiogenic shock complicates 5-10 % of acute MI cases, and despite advances in acute care there remains the same incidence (~60,000-70,000 patients per year in Europe). 2,4 Historically, MI complicated by cardiogenic shock was associated with a mortality rate of 80-90 %. 5 However, with advances in coronary reperfusion techniques over the past few decades, especially with the introduction of primary percutaneous coronary intervention (PCI), the mortality rate has improved to below 50 %. 4,[6][7][8][9][10][11][12] The trend towards better outcomes may also be due to greater awareness of the need for timely treatment, improvements in the medical care of haemodynamically unstable patients as well as the use of mechanical support devices, although this has not yet been clearly demonstrated.Despite this high mortality rate, it is important to note that patients with cardiogenic shock who survive to discharge have a long-term outcome similar to that of patients without cardiogenic shock, with a good functional outcome at 1 year. 13,14 This highlights the importance of improving the chance of early survival among patients in cardiogenic shock. Management Myocardial ReperfusionThere is evidence that the high mortality rates associated with cardiogenic shock have improved over time. 7,9,11,15,16 This benefit is thought to be due to increased use of coronary revascularisation strategies, which, by restoring flow to the ischaemic myocardium, can limit infarct size as well as interrupt the downward spiral that characterises cardiogenic shock. 7,9,15 As such, the cornerstone of the management of cardiogenic shock complicating acute MI is prompt revascularisation, as highlighted in AbstractCardiogenic shock complicates approximately 5-10 % of all MI events and remains the most common cause of death among MI cases. Over the past few decades, the mortality rate associated with cardiogenic shock has decreased with the introduction of early revascularisation, although there are limited data for patients with triple-vessel disease and left main stem disease. In more recent years, there have been a number of advances in the mechanical circulatory support devices that can help improv...

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Temporal Trends in Cardiogenic Shock Complicating Acute Myocardial Infarction

Cited by 538 publications

References 37 publications

Predictive factors of in-hospital mortality and of severe perioperative complications in myocardial revascularization surgery

Predictive factors of in-hospital mortality and of severe perioperative complications in myocardial revascularization surgery

Echocardiographic Predictors of Survival and Response to Early Revascularization in Cardiogenic Shock

Primary Angioplasty For Patients in Cardiogenic Shock: Optimal Management

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