TY - JOUR
T1 - Improved outcome of cardiogenic shock at the acute stage of myocardial infarction
T2 - A report from the USIK 1995, USIC 2000, and FAST-MI French Nationwide Registries
AU - Aissaoui, Nadia
AU - Puymirat, Etienne
AU - Tabone, Xavier
AU - Charbonnier, Bernard
AU - Schiele, Francois
AU - Lefèvre, Thierry
AU - Durand, Eric
AU - Blanchard, Didier
AU - Simon, Tabassome
AU - Cambou, Jean Pierre
AU - Danchin, Nicolas
N1 - Funding Information:
We are indebted to all patients having accepted to participate in the surveys, and to all participating physicians. USIK 1995 was a registry funded by Roussel. USIC 2000 was funded by Aventis France. Special thanks to Laurent Vaur, MD, who was at the initiative of both surveys. The FAST-MI 2005 registry is a registry of the French Society of Cardiology, funded by unrestricted grants from Pfizer and Servier, and an additional grant from the Caisse Natio-nale d’Assurance Maladie. Special thanks to all involved in the FAST-MI 2005 registry: ICTA contract research organization (Fontaine-lès-Dijon, France), and the devoted personnel of the URCEST (Assistance Publique des Hôpitaux de Paris and University Paris 6) and INSERM U 558 (Toulouse). Special thanks to Vincent Bataille, for his careful data management, to Benoît Pace (Société Franc¸aise de Cardiologie) for his invaluable assistance in designing the electronic CRF, and to Geneviève Mulak (Société Franc¸aise de Cardiologie) and Elodie Drouet, who supervised the patients’ follow-up.
PY - 2012/10
Y1 - 2012/10
N2 - Aim The historical evolution of incidence and outcome of cardiogenic shock (CS) in acute myocardial infarction (AMI) patients is debated. This study compared outcomes in AMI patients from 1995 to 2005, according to the presence of CS.Method and resultsThree nationwide French registries were conducted 5 years apart, using a similar methodology in consecutive patients admitted over a 1-month period. All 7531 AMI patients presenting ≤48 h of symptom onset were included. The evolution of mortality was compared in the 486 patients with CS vs. those without CS. The incidence of CS tended to decrease over time (6.9 in 1995; 5.7 in 2005, P 0.07). Thirty-day mortality was considerably higher in CS patients (60.9 vs. 5.2). Over the 10-year period, mortality decreased for both patients with (70-51, P 0.003) and without CS (9-4, P < 0.001). In CS patients, the use of percutaneous coronary intervention (PCI) increased from 20 to 50 (P < 0.001). Time period was an independent predictor of early mortality in CS patients (OR for death, 2005 vs. 1995 0.45; 95 CI: 0.27-0.75, P 0.005), along with age, diabetes, and smoking status. When added to the multivariate model, PCI was associated with decreased mortality (OR 0.38; 95 CI: 0.24-0.58, P < 0.001). In propensity-score-matched cohorts, CS patients with PCI had a significantly higher survival.ConclusionsCardiogenic shock remains a clinical concern, although early mortality has decreased. Improved survival is concomitant with a broader use of PCI and recommended medications at the acute stage. Beyond the acute stage, however, 1-year survival has remained unchanged.
AB - Aim The historical evolution of incidence and outcome of cardiogenic shock (CS) in acute myocardial infarction (AMI) patients is debated. This study compared outcomes in AMI patients from 1995 to 2005, according to the presence of CS.Method and resultsThree nationwide French registries were conducted 5 years apart, using a similar methodology in consecutive patients admitted over a 1-month period. All 7531 AMI patients presenting ≤48 h of symptom onset were included. The evolution of mortality was compared in the 486 patients with CS vs. those without CS. The incidence of CS tended to decrease over time (6.9 in 1995; 5.7 in 2005, P 0.07). Thirty-day mortality was considerably higher in CS patients (60.9 vs. 5.2). Over the 10-year period, mortality decreased for both patients with (70-51, P 0.003) and without CS (9-4, P < 0.001). In CS patients, the use of percutaneous coronary intervention (PCI) increased from 20 to 50 (P < 0.001). Time period was an independent predictor of early mortality in CS patients (OR for death, 2005 vs. 1995 0.45; 95 CI: 0.27-0.75, P 0.005), along with age, diabetes, and smoking status. When added to the multivariate model, PCI was associated with decreased mortality (OR 0.38; 95 CI: 0.24-0.58, P < 0.001). In propensity-score-matched cohorts, CS patients with PCI had a significantly higher survival.ConclusionsCardiogenic shock remains a clinical concern, although early mortality has decreased. Improved survival is concomitant with a broader use of PCI and recommended medications at the acute stage. Beyond the acute stage, however, 1-year survival has remained unchanged.
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U2 - 10.1093/eurheartj/ehs264
DO - 10.1093/eurheartj/ehs264
M3 - Article
C2 - 22927559
AN - SCOPUS:84867692194
SN - 0195-668X
VL - 33
SP - 2535
EP - 2543
JO - European Heart Journal
JF - European Heart Journal
IS - 20
ER -