Acute Ischemic Heart Disease
Recent magnitude of and temporal trends (1994-1997) in the incidence and hospital death rates of cardiogenic shock complicating acute myocardial infarction: The second National Registry of Myocardial Infarction

https://doi.org/10.1067/mhj.2001.111405Get rights and content

Abstract

Background Limited recent data are available to describe the magnitude of, and temporal trends in, the incidence and case-fatality rates associated with cardiogenic shock complicating acute myocardial infarction. The purpose of this study was to examine recent (1994-1997) trends in the incidence of, and hospital death rates from, cardiogenic shock complicating acute myocardial infarction from a large, multihospital national perspective. Methods An observational study was performed of 426,253 patients hospitalized with acute myocardial infarction in 1662 hospitals throughout the United States between 1994 and 1997. Results The incidence rates of cardiogenic shock averaged 6.2%. There was evidence for a slight decline in these rates between 1994 (6.6%) and 1997 (6.0%). Results of a multivariable regression analysis controlling for factors that might affect the risk of development of cardiogenic shock indicated that patients hospitalized in more recent years were at significantly lower risk for shock. Patients with shock had a markedly increased risk for dying during hospitalization compared with patients not having shock (74% vs 10%). Significant, albeit small, absolute differences were observed in the risk of dying after cardiogenic shock over time (76% dying in 1997, 72% dying in 1994). These improving trends were magnified, however, after potentially confounding prognostic factors were controlled: patients having shock in 1997 were at approximately one fifth lower risk of dying (odds ratio 0.79, 95% confidence interval 0.71-0.87) than those hospitalized in 1994. Conclusions Our findings indicate a slight decline in the incidence rates of cardiogenic shock and improving trends in the hospital survival of patients with shock. Despite these trends, it remains of considerable importance to prevent this clinical syndrome, given its high lethality. (Am Heart J 2001;141:65-72.)

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Methods

The Second National Registry of Myocardial Infarction (NRMI-2) is a cross-sectional observational study of patients hospitalized with AMI throughout the United States that has been ongoing since 1994. This voluntary registry of patients with AMI is sponsored by Genentech, Inc. The data collection process at each site and quality control features of the NRMI-2 have been previously described.17, 18 The purpose of NRMI-2 is to monitor trends in national treatment practices in patients hospitalized

Incidence rates of cardiogenic shock

A total of 426,253 patients with AMI were enrolled in the registry over the 4-year period under study; this included 45,860 in 1994, 120,136 in 1995, 130,426 in 1996, and 129,831 in 1997. Fewer patients were studied in 1994 because of closing of the NRMI-1 registry and beginning of new data collection activities for NRMI-2. The overall percentage of patients with AMI having cardiogenic shock was 6.2%. There was suggestion of a slight decline in the percentage of AMI patients with cardiogenic

Discussion

The results of this large observational study in patients hospitalized with AMI in nearly one fourth of all US hospitals suggest slight declines in the proportion of patients with AMI having cardiogenic shock and encouraging declines in hospital mortality associated with cardiogenic shock although these death rates remain markedly elevated in comparison to AMI patients not having shock.

The incidence of cardiogenic shock after AMI ranges between 5% and 15% in published studies. This relatively

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Reprint requests: Robert Goldberg, PhD, Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical Schoool, 55 Lake Ave N, Worcester, MA 01655. E-mail: [email protected]

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