NCDR Study Finds AMI Patients With Cardiogenic Shock do Poorly After Hospital Discharge
Patients who experience acute myocardial infarction (AMI) and cardiogenic shock may have a higher risk of death or rehospitalization than non-shock patients in the first 60 days post-discharge, but by the end of the first year, the gap between the two groups narrows, according to a study published Feb. 15 in the Journal of the American College of Cardiology (JACC).
Using data from ACC's ACTION Registry-GWTG linked with Centers for Medicare and Medicaid Services' claims data, researchers examined records from 112,561 AMI patients treated at 677 U.S. hospitals between January 2007 and September 2012. Of this group, almost 5 percent experienced cardiogenic shock during the initial hospitalization.
Researchers found that at 60 days, almost 34 percent of shock patients were rehospitalized or had died, compared with about 25 percent of non-shock patients. At the one-year mark, however, about 59 percent of shock patients were rehospitalized or had died, compared with about 52 percent of patients without shock.
Rashmee Shah, MD, the study's lead author, explains that moving forward, "there is a need to address the vulnerable immediate post-hospital period" and identify appropriate interventions.
In an accompanying editorial, Adnan Kastrati, MD, says the findings support the theory that early survival is determined predominately by the extent of damaged muscle, while late survival is related to lower baseline risk. He suggests that the high mortality rates for shock patients "should motivate us to search for ways to improve outcomes," including the best way to address multivessel coronary artery disease and reverse cardiogenic shock.
"We have to better understand this pattern of early mortality versus late survivorship," comments Valentin Fuster, MD, PhD, MACC, JACC editor-in-chief. "We need to better understand the mechanism, in order to possibly convert these early mortality rates." Listen to Fuster's full audio commentary here.
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