Long-Term Outcomes of Cardiogenic Shock Complicating MI
- Findings from this population-based analysis showed that the incidence of AMI-CS increased steadily over time from 2009–2019.
- Nearly one third of patients died during initial hospitalization, 40% died within 1 year, and approximately 60% died within 5 years.
- A significant number of survivors required increased support at home and had high readmission rates.
What are long-term clinical outcomes among patients with cardiogenic shock secondary to acute myocardial infarction (AMI-CS)?
All adult patients (≥18 years of age) with a diagnosis of AMI-CS in the province of Ontario from April 1, 2009, through March 31, 2019, were included. The primary outcome was hospital mortality. Secondary outcomes included mortality at 30 days, 1 year, 2 years, and 5 years among the entire cohort. Additionally, mortality at 30 days, 1 year, 2 years, and 5 years among survivors of the index hospital stay were evaluated.
A total of 9,789 consecutive patients with AMI-CS from 135 centers were included. Mean age was 70.5 ± 12.3 years, and 67.7% were male. The incidence of AMI-CS was 8.2 per 100,000 person-years, and increased over the study period. Critical care interventions were common, with 5,422 (55.4%) receiving invasive mechanical ventilation, 1,425 (14.6%) receiving renal replacement therapy, and 1,484 (15.2%) receiving mechanical circulatory support. A total of 2,961 patients (30.2%) died in hospital, and 4,004 (40.9%) died by 1 year. Mortality at 5 years was 58.9%. Small improvements in short- and long-term mortality were seen over the study period. Among survivors to discharge, 2,870 (42.0%) required increased support in care from their preadmission baseline, 3,244 (47.5%) were readmitted to the hospital within 1 year, and 1,047 (15.3%) died within 1 year. The mean days at home in the year following discharge was 307.9 ± 109.6.
Short- and long-term mortality among patients with AMI-CS is high, with minimal improvement over time. AMI-CS survivors experience significant morbidity, with high risk of readmission and death. Future studies should evaluate interventions to minimize post-discharge morbidity and mortality among AMI-CS survivors.
Data on long-term outcomes among survivors of AMI-CS are sparse. Findings from this population-based analysis showed that the incidence of AMI-CS increased steadily over time (2009–2019). Nearly one third of patients died during initial hospitalization, 40% died within 1 year, and approximately 60% died within 5 years. In addition, a significant number of survivors required increased support at home and had high readmission rates. Although the results have inherent limitations due to study design, they highlight the impact of AMI-CS and need for interventions that will help improve long-term morbidity and mortality among survivors.
Keywords: Acute Coronary Syndrome, Acute Heart Failure, Critical Care, Geriatrics, Myocardial Infarction, Patient Discharge, Patient Readmission, Renal Replacement Therapy, Respiration, Artificial, Secondary Prevention, Shock, Cardiogenic, Survivors, Ventilators, Mechanical
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