Ten-Year (2001-2011) Trends in the Incidence Rates and Short-Term Outcomes of Early Versus Late Onset Cardiogenic Shock After Hospitalization for Acute Myocardial Infarction

Background: Cardiogenic shock (CS) is a serious complication of acute myocardial infarction (AMI), and the time of onset of CS has a potential role in influencing its prognosis. Limited contemporary data exist on this complication, however, especially from a population-based perspective. Our study objectives were to describe decade long trends in the incidence, in-hospital mortality, and factors associated with the development of CS in 3 temporal contexts: (i) prior to hospital arrival for AMI (pre-hospital CS); (ii) within 24 hours of hospitalization (early CS); and (iii) ≥24 hours after hospitalization (late CS).
Methods and Results: The study population consisted of 5,782 patients with an AMI who were admitted to all 11 hospitals in central Massachusetts on a biennial basis between 2001 and 2011. The overall proportion of patients who developed CS was 5.2%. The proportion of patients with pre-hospital CS (1.6%) and late CS (1.5%) remained stable over time, whereas the proportion of patients with early CS declined from 2.2% in 2001/2003 to 1.2% in 2009/2011. In-hospital mortality for pre-hospital CS increased from 38.9% in 2001/2003 to 53.6% in 2009/2011, whereas in-hospital mortality for early and late CS decreased over time (35.9% and 64.7% in 2001/2003 to 15.8% and 39.1% in 2009/2011, respectively).
Conclusions: Development of pre-hospital and in-hospital CS was associated with poor short-term survival and the in-hospital death rates among those with pre-hospital CS increased over time. Interventions focused on preventing or treating prehospital and late CS are needed to improve in-hospital survival after AMI.