Background: The diagnosis and treatment of patients admitted with cardiogenic shock in the past decade has changed. Limited information is available on the effect of these changes in terms of incidence, management, and outcomes of cardiogenic shock in Israel.
Methods: We evaluated time-dependent changes in the clinical characteristics, management strategies, and outcomes of patients admitted with the diagnosis of cardiogenic shock and enrolled in the biannual Acute Coronary Syndrome Israeli Surveys (ACSIS) between 2000 and 2013. Survey periods were categorized as early (years 2000-2004) and late (year 2006-2013).
Results: A total of 224 patients were admitted with the diagnosis of cardiogenic shock during the surveys years 2000-2013. The mean age of patients [(70.52±13.67 vs. 68.95±13.22 (p=0.35)] did not change significantly in the last decade, but in late survey years, the patients were more often diabetic, hypertensive, dyslipdemic and more frequently with history of CVA and other comorbidities. Dyspnea or heart failure and sudden cardiac death as the initial presentation were more prevalent in the late survey group. On admission the rate of primary PCI were notably higher in late survey years [30.6% vs. 57.8% (p<0.001)], while fibrynolysis treatment was prevalent only in early survey years. Also, the patients in the later years survey group received more aggressive medical therapy, with increase use of DAPT, beta-blockers, ACEi, statins and IIb/IIIa. The need for adjunctive therapy such as intra-aortic balloon pump (IABP) or need for mechanical ventilation were similar in both groups. An improved short term clinical outcome was observed in the later survey group [7 days mortality rates (44.4% vs. 31.3%, p=0.04], and a trend to lower rate of 30 days MACE events (57.4% vs. 45.7%, p=0.07), but similar long-term mortality rate at 1 year in both groups.
Conclusion: In patients with cardiogenic shock, in spite of the more intensive medical, mechanical and interventional measures applied during recent years there is only a small benefit in short term mortality which in not present later on. The reason for the stable mortality rates could be partly explained by the fact that the later years survey patients had more comorbidities than the parallel group. Patients presented with cardiogenic shock represent an extremely sick cohort, in whom even the most intensive means of treatment results in poor long term prognosis.
