BACKGROUND. Cardiogenic shock resulting from acute myocardial infarction is a serious complication with a high mortality rate, but little is known about whether its incidence or outcome has changed over time. As part of an ongoing population-based study of acute myocardial infarction, we examined trends over time in the incidence and mortality rate of cardiogenic shock after acute myocardial infarction. METHODS. We studied 4762 patients with acute myocardial infarction who were admitted to 16 hospitals in the Worcester, Massachusetts, metropolitan area between 1975 and 1988. We determined the incidence of and short-term and long-term mortality due to cardiogenic shock in each of six years during this study period. RESULTS. The incidence of cardiogenic shock complicating acute myocardial infarction remained relatively constant, averaging 7.5 percent. Multivariate regression analysis that controlled for variables affecting incidence revealed significant though inconsistent temporal trends in the incidence of cardiogenic shock. As compared with the risk in 1975, the adjusted relative risk (with 95 percent confidence interval) was 0.83 (0.54 to 1.28) in 1978, 0.96 (0.63 to 1.48) in 1981, 0.68 (0.42 to 1.12) in 1984, 1.16 (0.70 to 1.92) in 1986, and 1.65 (0.99 to 2.77) in 1988. The overall in-hospital mortality rate among patients with cardiogenic shock was significantly higher than that among patients without this complication (77.7 percent vs. 13.5 percent, P less than 0.001). The in-hospital mortality among the patients with shock did not improve between 1975 (73.7 percent) and 1988 (81.7 percent). Long-term survival during the 14-year follow-up period was significantly worse among patients who survived cardiogenic shock during hospitalization than among patients who did not have shock (P less than 0.001). CONCLUSIONS. The results of this observational, community-wide study suggest that neither the incidence nor the prognosis of cardiogenic shock resulting from acute myocardial infarction has improved over time. Both in-hospital and long-term survival remain poor for patients with this complication.
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Department of Medicine, University of Massachusetts Medical School, Worcester 01655.
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118: 924-929
[Abstract][Full Text]
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341: 625-634
[Abstract][Full Text]
Hollenberg, S. M., Kavinsky, C. J., Parrillo, J. E.
(1999). Cardiogenic Shock. ANN INTERN MED
131: 47-59
[Abstract][Full Text]
Goldberg, R. J., Yarzebski, J., Lessard, D., Gore, J. M.
(1999). A two-decades (1975 to 1995) long experience in the incidence, in-hospital and long-term case-fatality rates of acute myocardial infarction: a community-wide perspective. J Am Coll Cardiol
33: 1533-1539
[Abstract][Full Text]
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(1999). ACC/AHA guidelines for coronary angiography: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) developed in collaboration with the Society for Cardiac Angiography and Interventions. J Am Coll Cardiol
33: 1756-1824
[Full Text]
Goldberg, R. J., Samad, N. A., Yarzebski, J., Gurwitz, J., Bigelow, C., Gore, J. M.
(1999). Temporal Trends in Cardiogenic Shock Complicating Acute Myocardial Infarction. NEJM
340: 1162-1168
[Abstract][Full Text]
Wharton, T. P. Jr., McNamara, N. S., Fedele, F. A., Jacobs, M. I., Gladstone, A. R., Funk, E. J.
(1999). Primary angioplasty for the treatment of acute myocardial infarction: experience at two community hospitals without cardiac surgery. J Am Coll Cardiol
33: 1257-1265
[Abstract][Full Text]
McCormick, D., Gurwitz, J. H., Lessard, D., Yarzebski, J., Gore, J. M., Goldberg, R. J.
(1999). Use of Aspirin, {beta}-Blockers, and Lipid-Lowering Medications Before Recurrent Acute Myocardial Infarction: Missed Opportunities for Prevention?. Arch Intern Med
159: 561-567
[Abstract][Full Text]
Bueno, H., Lopez-Palop, R., Perez-David, E., Garcia-Garcia, J., Lopez-Sendon, J. L., Delcan, J. L.
(1998). Combined Effect of Age and Right Ventricular Involvement on Acute Inferior Myocardial Infarction Prognosis. Circulation
98: 1714-1720
[Abstract][Full Text]
LIM, R., WALTERS, M. I, NORELL, M. S
(1997). Transferring patients for primary infarct angioplasty. Heart
78: 325-326
[Full Text]
Bueno, H., Lopez-Palop, R., Bermejo, J., Lopez-Sendon, J. L., Delcan, J. L.
(1997). In-Hospital Outcome of Elderly Patients With Acute Inferior Myocardial Infarction and Right Ventricular Involvement. Circulation
96: 436-441
[Abstract][Full Text]
Nanas, J. N., Lolas, C. T., Charitos, C. E., Nanas, S. N., Margari, Z. J., Agapitos, E. V., Moulopoulos, S. D.
(1996). A VAVLELESS HIGH STROKE VOLUME COUNTERPULSATION DEVICE RESTORES HEMODYNAMICS IN PATIENTS WITH CONGESTIVE HEART FAILURE AND INTRACTABLE CARDIOGENIC SHOCK AWAITING HEART TRANSPLANTATION. J. Thorac. Cardiovasc. Surg.
111: 55-61
[Abstract][Full Text]
COMMITTEE MEMBERS, , WILLIAMS, J. F. Jr, BRISTOW, M. R., FOWLER, M. B., FRANCIS, G. S., GARSON, A. Jr, GERSH, B. J., HAMMER, D. F., HLATKY, M. A., LEIER, C. V., PACKER, M., PITT, B., ULLYOT, D. J., WEXLER, L. F., WINTERS, W. L. Jr, TASK FORCE MEMBERS, , RITCHIE, J. L., CHEITLIN, M. D., EAGLE, K. A., GARDNER, T. J., GARSON, A. Jr, GIBBONS, R. J., LEWIS, R. P., O'ROURKE, R. A., RYAN, T. J.
(1995). Guidelines for the Evaluation and Management of Heart Failure : Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Evaluation and Management of Heart Failure). Circulation
92: 2764-2784
[Full Text]
Redelmeier, D. A., Koehler, D. J., Liberman, V., Tversky, A.
(1995). Probability Judgment in Medicine: Discounting Unspecified Possibilities. Med Decis Making
15: 227-230
[Abstract]
Hochman, J. S., Boland, J., Sleeper, L. A., Porway, M., Brinker, J., Col, J., Jacobs, A., Slater, J., Miller, D., Wasserman, H., Menegus, M. A., Talley, J. D., McKinlay, S., Sanborn, T., LeJemtel, T.
(1995). Current Spectrum of Cardiogenic Shock and Effect of Early Revascularization on Mortality : Results of an International Registry. Circulation
91: 873-881
[Abstract][Full Text]
Califf, R. M., Bengtson, J. R.
(1994). Cardiogenic Shock. NEJM
330: 1724-1730
[Full Text]
