Outcomes of Patients With Acute MI With Cardiogenic Shock

Study Questions:

What is the outcome of survivors of cardiogenic shock complicating myocardial infarction (MI)?

Methods:

The authors linked data from the ACTION Registry–GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry–Get With The Guidelines) with Medicare claims data and assessed post-hospital outcome of elderly patients with MI.

Results:

Cardiogenic shock was present among 5% of the 112,668 patients with MI who survived to hospital discharge. Those with cardiogenic shock had higher unadjusted mortality at 60 days (9.6% vs. 5.5%) and at 1 year (22% vs. 17%). After adjusting for confounders, the mortality at 60 days remained high (adjusted hazard ratio [HR], 1.62; 95% confidence interval [CI], 1.46-1.80), but was not different at 1 year. The rate of death or hospitalization also was higher in the first 60 days (34% vs. 25%; adjusted HR, 1.28; 95% CI, 1.21-1.35).

Conclusions:

Elderly patients surviving cardiogenic shock complicating MI have an increased risk of death and rehospitalization in the first 60 days after discharge.

Perspective:

The outcome of shock has improved compared to historic controls, but more recent data suggest that the survival has not improved further in the last few years. This study demonstrated the marked increased risk of death in these patients early after discharge, although the subsequent outcomes are similar to those with MI. Further studies are needed to understand the mediators of, and to develop and explore strategies that can mitigate this increased early hazard.

Clinical Topics: Acute Coronary Syndromes, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: ACTION Registry-GWTG, Acute Coronary Syndrome, Geriatrics, Medicare, Myocardial Infarction, Patient Discharge, Patient Outcome Assessment, Shock, Shock, Cardiogenic, Survivors


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