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Decreasing Incidence of Cardiogenic Shock
Summary and Comment by J. Stephen Bohan, MD, MS, FACP, FACEP
Published in Journal Watch Emergency MedicineDecember 12, 2008
The incidence of development of shock during hospitalization in patients with MI decreased during the past 10 years, while the incidence of shock at admission did
not change.
Copyright © 2008. Massachusetts Medical Society. All rights reserved.
Covering
• Jeger RV et al. Ten-year trends in the incidence and treatment of cardiogenic shock. Ann Intern Med 2008 Nov 4; 149:618.
Copyright © 2008. Massachusetts Medical Society. All rights reserved.
Background
• To determine trends in the incidence of cardiogenic shock and identify factors that influence outcomes, researchers analyzed medical records of 23,700 patients who were admitted to 70 hospitals in Switzerland with diagnoses of myocardial infarction from 1997 through 2006.
Copyright © 2008. Massachusetts Medical Society. All rights reserved.
The Research
• Of the 1977 patients (8.3%) in cardiogenic shock, 29% had shock on admission and 71% developed shock during hospitalization.
• Among patients hospitalized with MI, the incidence of developing shock during hospitalization declined significantly during the 10-year study period (from 11% to 3%), while the rate of shock on admission remained stable (at about 2% to 3%).
• Death rates from shock declined (from 63% to 48% overall), both in patients who had shock on admission and in those who developed shock during hospitalization.
• The incidence of shock was significantly higher in patients with ST-segment-elevation MI (STEMI) than in those with non-STEMI and in patients aged 75 or older than in younger patients (the older group also received fewer interventions).
Copyright © 2008. Massachusetts Medical Society. All rights reserved.
The Research
• Percutaneous coronary intervention and β-blocker therapy each was associated with a strongly significant reduction in death during hospitalization (odds ratios, 0.47 and 0.59, respectively).
• The authors attribute the decline in development of shock during hospitalization to increased use of revascularization procedures, aspirin, β-blockers, and antithrombin agents.
Copyright © 2008. Massachusetts Medical Society. All rights reserved.
Comment
• Cardiogenic shock is highly lethal, but the likelihood of developing shock after acute MI clearly can be reduced by modern multimodal treatment, beginning in the emergency department.
Copyright © 2008. Massachusetts Medical Society. All rights reserved.
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Copyright © 2008. Massachusetts Medical Society. All rights reserved.
