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- Title
Temporal trends in the epidemiology, management, and outcome of patients with cardiogenic shock complicating acute coronary syndromes.
- Authors
De Luca, Leonardo; Olivari, Zoran; Farina, Andrea; Gonzini, Lucio; Lucci, Donata; Di Chiara, Antonio; Casella, Gianni; Chiarella, Francesco; Boccanelli, Alessandro; Di Pasquale, Giuseppe; De Servi, Stefano; Bovenzi, Francesco Maria; Gulizia, Michele Massimo; Savonitto, Stefano
- Abstract
<bold>Aims: </bold>Despite advances in the management of patients with acute coronary syndrome (ACS), cardiogenic shock (CS) remains the leading cause of death in these patients. We describe the evolution of clinical characteristics, in-hospital management, and outcome of patients with CS complicating ACS.<bold>Methods and Results: </bold>We analysed data from five Italian nationwide prospective registries, conducted between 2001 and 2014, including consecutive patients with ACS. Out of 28 217 ACS patients enrolled, 1209 (4.3%) had CS: 526 (44%) at the time of admission and 683 (56%) later on during hospitalization. Over the years, a reduction in the incidence of CS was observed, even though this was not statistically significant (P for trend = 0.17). The proportions of CS patients with a history of heart failure declined, whereas the proportion of those with hypertension, renal dysfunction, previous PCI, and AF significantly increased. The use of PCI considerably increased from 2001 to 2014 [19% to 60%; percentage change 41, 95% confidence interval (CI) 29-51]. In-hospital mortality of CS patients decreased from 68% (95% CI 59-76) in 2001 to 38% (95% CI 29-47) in 2014 (percentage change -30, 95% CI -41 to -18). Compared with 2001, the risk of death was significantly lower in all of the registries, with reductions in adjusted mortality between 45% and 66%.<bold>Conclusions: </bold>Over the last 14 years, substantial changes occurred in the clinical characteristics and management of patients with CS complicating ACS, with a greater use of PCI and a significant reduction in adjusted mortality rate.
- Subjects
ITALY; EPIDEMIOLOGY; CARDIOGENIC shock; ACUTE coronary syndrome; HOSPITAL administration; DISEASE complications; DATA analysis; DEATH rate; HEALTH outcome assessment; TREATMENT of acute coronary syndrome; ELECTROCARDIOGRAPHY; HEART failure; EVALUATION of medical care; MYOCARDIAL revascularization; STATISTICS; TRANSLUMINAL angioplasty; DISEASE management; DISEASE incidence; ACQUISITION of data; HOSPITAL mortality; CORONARY angiography; DIAGNOSIS; THERAPEUTICS
- Publication
European Journal of Heart Failure, 2015, Vol 17, Issue 11, p1124
- ISSN
1388-9842
- Publication type
journal article
- DOI
10.1002/ejhf.339