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Trends in first-time hospitalization, management, and short-term mortality in acute myocardial infarction–related cardiogenic shock from 2005 to 2017: A nationwide cohort study

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@article{6114e7a5d3a043d981604d00c42ee74e,
title = "Trends in first-time hospitalization, management, and short-term mortality in acute myocardial infarction–related cardiogenic shock from 2005 to 2017: A nationwide cohort study",
abstract = "BACKGROUND: Cardiogenic shock remains the leading cause of in-hospital death in acute myocardial infarction (AMI). Due to temporary changes in management of cardiogenic shock with widespread implementation of early revascularization along with increasing attention to the use of mechanical circulatory devices, complete and longitudinal data are important in this subject. The objective of this study was to examine temporal trends of first-time hospitalization, management, and short-term mortality for patients with AMI-related cardiogenic shock (AMICS).METHODS: Using nationwide medical registries, we identified patients hospitalized with first-time AMI and cardiogenic shock from January 1, 2005 through December 31, 2017. We calculated annual incidence proportions of AMICS. Thirty-day mortality was estimated with use of Kaplan-Meier estimator comparing AMICS and AMI-only patients. Multivariable Cox regression models were used to assess mortality rate ratios (MRR).RESULTS: We included 101,834 AMI patients of whom 7040 (7{\%}) had AMICS. The median age was 72 (interquartile range (IQR): 62-80) for AMICS and for AMI-only 69 (IQR: 58-79). The gender composition was similar between AMICS and AMI-only (Males: 64{\%} vs. 63{\%}). The annual incidence proportion of AMICS decreased slightly over time (2005: 7.0{\%} vs. 2017: 6.1{\%}, p for trend <0.0001). In AMICS, use of coronary angiography increased between 2005-2017 from 48{\%} to 71{\%}, as did use of left ventricular (LV) assist device (1{\%} vs. 10{\%}) and norepinephrine (30{\%} to 70{\%}). In contrast, use of intra-aortic balloon pump (14{\%} vs. 1{\%}) and dopamine (34{\%} vs. 20{\%}) decreased. Thirty-day mortality for AMICS patients were 60{\%} (95{\%}CI: 59-61) and substantially higher than the 8{\%} (95{\%}CI: 7.8-8.2) for AMI-only (MRR: 11.4, 95{\%} CI: 10.9-11.8). Over time, the mortality decreased after AMICS (2005: 68{\%} to 2017: 57{\%}, p for temporal change in adjusted analysis <0.0001).CONCLUSION: We observed a slight decrease in AMICS hospitalization over time with changing practice patterns. Thirty-day mortality was markedly higher for patients with AMICS compared with AMI-only, yet, our results suggest improved 30-day survival over time after AMICS.",
author = "Lauridsen, {Marie Dam} and Rasmus Rorth and Lindholm, {Matias Greve} and Jesper Kjaergaard and Morten Schmidt and M{\o}ller, {Jacob Eifer} and Christian Hassager and Christian Torp-Pedersen and Gunnar Gislason and Lars K{\o}ber and Fosbol, {Emil Loldrup}",
note = "Copyright {\circledC} 2020 Elsevier Inc. All rights reserved.",
year = "2020",
month = "11",
doi = "10.1016/j.ahj.2020.08.012",
language = "English",
volume = "229",
pages = "127--137",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby, Inc",

}

RIS

TY - JOUR

T1 - Trends in first-time hospitalization, management, and short-term mortality in acute myocardial infarction–related cardiogenic shock from 2005 to 2017

T2 - A nationwide cohort study

AU - Lauridsen, Marie Dam

AU - Rorth, Rasmus

AU - Lindholm, Matias Greve

AU - Kjaergaard, Jesper

AU - Schmidt, Morten

AU - Møller, Jacob Eifer

AU - Hassager, Christian

AU - Torp-Pedersen, Christian

AU - Gislason, Gunnar

AU - Køber, Lars

AU - Fosbol, Emil Loldrup

N1 - Copyright © 2020 Elsevier Inc. All rights reserved.

PY - 2020/11

Y1 - 2020/11

N2 - BACKGROUND: Cardiogenic shock remains the leading cause of in-hospital death in acute myocardial infarction (AMI). Due to temporary changes in management of cardiogenic shock with widespread implementation of early revascularization along with increasing attention to the use of mechanical circulatory devices, complete and longitudinal data are important in this subject. The objective of this study was to examine temporal trends of first-time hospitalization, management, and short-term mortality for patients with AMI-related cardiogenic shock (AMICS).METHODS: Using nationwide medical registries, we identified patients hospitalized with first-time AMI and cardiogenic shock from January 1, 2005 through December 31, 2017. We calculated annual incidence proportions of AMICS. Thirty-day mortality was estimated with use of Kaplan-Meier estimator comparing AMICS and AMI-only patients. Multivariable Cox regression models were used to assess mortality rate ratios (MRR).RESULTS: We included 101,834 AMI patients of whom 7040 (7%) had AMICS. The median age was 72 (interquartile range (IQR): 62-80) for AMICS and for AMI-only 69 (IQR: 58-79). The gender composition was similar between AMICS and AMI-only (Males: 64% vs. 63%). The annual incidence proportion of AMICS decreased slightly over time (2005: 7.0% vs. 2017: 6.1%, p for trend <0.0001). In AMICS, use of coronary angiography increased between 2005-2017 from 48% to 71%, as did use of left ventricular (LV) assist device (1% vs. 10%) and norepinephrine (30% to 70%). In contrast, use of intra-aortic balloon pump (14% vs. 1%) and dopamine (34% vs. 20%) decreased. Thirty-day mortality for AMICS patients were 60% (95%CI: 59-61) and substantially higher than the 8% (95%CI: 7.8-8.2) for AMI-only (MRR: 11.4, 95% CI: 10.9-11.8). Over time, the mortality decreased after AMICS (2005: 68% to 2017: 57%, p for temporal change in adjusted analysis <0.0001).CONCLUSION: We observed a slight decrease in AMICS hospitalization over time with changing practice patterns. Thirty-day mortality was markedly higher for patients with AMICS compared with AMI-only, yet, our results suggest improved 30-day survival over time after AMICS.

AB - BACKGROUND: Cardiogenic shock remains the leading cause of in-hospital death in acute myocardial infarction (AMI). Due to temporary changes in management of cardiogenic shock with widespread implementation of early revascularization along with increasing attention to the use of mechanical circulatory devices, complete and longitudinal data are important in this subject. The objective of this study was to examine temporal trends of first-time hospitalization, management, and short-term mortality for patients with AMI-related cardiogenic shock (AMICS).METHODS: Using nationwide medical registries, we identified patients hospitalized with first-time AMI and cardiogenic shock from January 1, 2005 through December 31, 2017. We calculated annual incidence proportions of AMICS. Thirty-day mortality was estimated with use of Kaplan-Meier estimator comparing AMICS and AMI-only patients. Multivariable Cox regression models were used to assess mortality rate ratios (MRR).RESULTS: We included 101,834 AMI patients of whom 7040 (7%) had AMICS. The median age was 72 (interquartile range (IQR): 62-80) for AMICS and for AMI-only 69 (IQR: 58-79). The gender composition was similar between AMICS and AMI-only (Males: 64% vs. 63%). The annual incidence proportion of AMICS decreased slightly over time (2005: 7.0% vs. 2017: 6.1%, p for trend <0.0001). In AMICS, use of coronary angiography increased between 2005-2017 from 48% to 71%, as did use of left ventricular (LV) assist device (1% vs. 10%) and norepinephrine (30% to 70%). In contrast, use of intra-aortic balloon pump (14% vs. 1%) and dopamine (34% vs. 20%) decreased. Thirty-day mortality for AMICS patients were 60% (95%CI: 59-61) and substantially higher than the 8% (95%CI: 7.8-8.2) for AMI-only (MRR: 11.4, 95% CI: 10.9-11.8). Over time, the mortality decreased after AMICS (2005: 68% to 2017: 57%, p for temporal change in adjusted analysis <0.0001).CONCLUSION: We observed a slight decrease in AMICS hospitalization over time with changing practice patterns. Thirty-day mortality was markedly higher for patients with AMICS compared with AMI-only, yet, our results suggest improved 30-day survival over time after AMICS.

U2 - 10.1016/j.ahj.2020.08.012

DO - 10.1016/j.ahj.2020.08.012

M3 - Journal article

VL - 229

SP - 127

EP - 137

JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

ER -

ID: 60806302