Cardiogenic shock epidemiology and demographics
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2] Syed Musadiq Ali M.B.B.S.[3]
Overview
In defiance of the historic numbers of mortality from cardiogenic shock of 80% to 90%, in the modern era, this type of shock comprises a mortality risk of around 50%, in the face of the diagnostic and treatment techniques, which have greatly been developed in recent years. Depending on the demographic and clinical factors, this risk can range from 10% to 80%. The incidence of cardiogenic shock among patients with acute MI is approximately 5% to 10%.[1][2] Because atherosclerosis and myocardial infarction are both more frequent among males, cardiogenic shock is more common in this gender. However, because women tend to present with acute myocardial infarction at a later age, along with the fact that they have a greater chance of having multivessel coronary artery disease when they first develop symptoms, a greater proportion of women with acute MI develop cardiogenic shock.[3]
Epidemiology and Demographics
- With the improvements made in the time for diagnosis and therapeutic measures offered for acute myocardial infarction, in which increasing rates of use of primary PCI in recent years have a major role, the once very stable incidence of cardiogenic shock in this group of patients is finally declining.[4]
- Cardiogenic shock is still an important complication in 5-8% of patients presenting with ST elevation myocardial infarction[5][6] and 2.5% of those with non ST elevation myocardial infarction.[7][8]
- The high incidence of left ventricular dysfunction following myocardial infarction, cardiogenic shock due to right ventricle failure (incidence of 2.8%) has as high mortality risk as shock following left ventricle failure.[9] According to the SHOCK registry, both groups of patients benefit equally from revascularization procedures.[10] Also according to this registry, the 3 and 6 year survival rates of the group who underwent early revascularization were 41.4% and 32.8% respectively.[11]
- The time course evaluated by the GUSTO-I trial showed that, of the 41.000 patients with acute MI treated with fibrinolytic therapy, 0.8% were in shock on admission, an additional 5.3% developed shock after admission as a sudden event or as a gradual fall in blood pressure, and approximately 50% of the patients who developed shock after admission, did so within the first 24 hours after the MI.[12]
The increase in the use of primary PCI, as the main reperfusion strategy for MI, over thrombolysis, has also contributed to the decrease in the incidence of CHF.[13][14] Back in the prereperfusion era, the 30-day mortality for acute MI complicated by cardiogenic shock was about 80%. This number went down to 58%, according to the GUSTO I registry, in patients who were treated with thrombolysis.[15] Recently, improvements in mortality have been shown and confirmed, as by the GRACE registry, which studied a group of patients from 1999 to 2006, and that demonstrated a 24% decline in cardiogenic shock complicating acute MI, with the use of PCI reperfusion.[16]
Cardiogenic shock has shown to have greater incidence and mortality rate in certain classes of patients:
- Elderly[17][18][19]
- Diabetic patients[20]
- Larger extent of left ventricular injury[7][21][22]
- Female sex, although initially classified as an independent predictor of outcome,[23] studies have revealed that this assumption wasn't true.[18][24][25]
References
- ↑ Goldberg RJ, Samad NA, Yarzebski J, et al. Temporal trends in cardiogenic shock complicating acute myocardial infarction. N Engl J Med. Apr 15 1999;340(15):1162-8.
- ↑ Hasdai D, Holmes DR, Topol EJ, et al. Frequency and clinical outcome of cardiogenic shock during acute myocardial infarction among patients receiving reteplase or alteplase. Results from GUSTO-III. Global Use of Strategies to Open Occluded Coronary Arteries. Eur Heart J. Jan 1999;20(2):128-35.
- ↑ Hasdai D, Califf RM, Thompson TD, et al. Predictors of cardiogenic shock after thrombolytic therapy for acute myocardial infarction. J Am Coll Cardiol. Jan 2000;35(1):136-43.
- ↑ Hasdai, David. (2002). Cardiogenic shock : diagnosis and treatmen. Totowa, N.J.: Humana Press. ISBN 1-58829-025-5.
- ↑ Fox KA, Anderson FA, Dabbous OH, Steg PG, López-Sendón J, Van de Werf F; et al. (2007). "Intervention in acute coronary syndromes: do patients undergo intervention on the basis of their risk characteristics? The Global Registry of Acute Coronary Events (GRACE)". Heart. 93 (2): 177–82. doi:10.1136/hrt.2005.084830. PMC 1861403. PMID 16757543.
- ↑ Babaev A, Frederick PD, Pasta DJ, Every N, Sichrovsky T, Hochman JS; et al. (2005). "Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock". JAMA. 294 (4): 448–54. doi:10.1001/jama.294.4.448. PMID 16046651.
- ↑ 7.0 7.1 Hasdai D, Harrington RA, Hochman JS, Califf RM, Battler A, Box JW; et al. (2000). "Platelet glycoprotein IIb/IIIa blockade and outcome of cardiogenic shock complicating acute coronary syndromes without persistent ST-segment elevation". J Am Coll Cardiol. 36 (3): 685–92. PMID 10987585.
- ↑ Thom T, Haase N, Rosamond W, Howard VJ, Rumsfeld J, Manolio T; et al. (2006). "Heart disease and stroke statistics--2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee". Circulation. 113 (6): e85–151. doi:10.1161/CIRCULATIONAHA.105.171600. PMID 16407573.
- ↑ Jacobs AK, Leopold JA, Bates E, Mendes LA, Sleeper LA, White H; et al. (2003). "Cardiogenic shock caused by right ventricular infarction: a report from the SHOCK registry". J Am Coll Cardiol. 41 (8): 1273–9. PMID 12706920.
- ↑ Hochman, Judith S; Buller, Christopher E; Sleeper, Lynn A; Boland, Jean; Dzavik, Vladimir; Sanborn, Timothy A; Godfrey, Emilie; White, Harvey D; Lim, John; LeJemtel, Thierry (2000). "Cardiogenic shock complicating acute myocardial infarction—etiologies, management and outcome: a report from the SHOCK Trial Registry". Journal of the American College of Cardiology. 36 (3): 1063–1070. doi:10.1016/S0735-1097(00)00879-2. ISSN 0735-1097.
- ↑ Hochman JS, Sleeper LA, Webb JG, Dzavik V, Buller CE, Aylward P; et al. (2006). "Early revascularization and long-term survival in cardiogenic shock complicating acute myocardial infarction". JAMA. 295 (21): 2511–5. doi:10.1001/jama.295.21.2511. PMC 1782030. PMID 16757723. Review in: ACP J Club. 2006 Nov-Dec;145(3):59
- ↑ Holmes DR, Bates ER, Kleiman NS, Sadowski Z, Horgan JH, Morris DC; et al. (1995). "Contemporary reperfusion therapy for cardiogenic shock: the GUSTO-I trial experience. The GUSTO-I Investigators. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries". J Am Coll Cardiol. 26 (3): 668–74. PMID 7642857.
- ↑ Goldberg, R. J.; Spencer, F. A.; Gore, J. M.; Lessard, D.; Yarzebski, J. (2009). "Thirty-Year Trends (1975 to 2005) in the Magnitude of, Management of, and Hospital Death Rates Associated With Cardiogenic Shock in Patients With Acute Myocardial Infarction: A Population-Based Perspective". Circulation. 119 (9): 1211–1219. doi:10.1161/CIRCULATIONAHA.108.814947. ISSN 0009-7322.
- ↑ Giglioli C, Margheri M, Valente S, Comeglio M, Lazzeri C, Chechi T; et al. (2006). "Timing, setting and incidence of cardiovascular complications in patients with acute myocardial infarction submitted to primary percutaneous coronary intervention". Can J Cardiol. 22 (12): 1047–52. PMC 2568965. PMID 17036099.
- ↑ Topol, Eric (2007). Textbook of cardiovascular medicine. Philadelphia: Lippincott Williams & Wilkins. ISBN 0781770122.
- ↑ Fox KA, Steg PG, Eagle KA, Goodman SG, Anderson FA, Granger CB; et al. (2007). "Decline in rates of death and heart failure in acute coronary syndromes, 1999-2006". JAMA. 297 (17): 1892–900. doi:10.1001/jama.297.17.1892. PMID 17473299.
- ↑ Hasdai D, Holmes DR, Califf RM, Thompson TD, Hochman JS, Pfisterer M; et al. (1999). "Cardiogenic shock complicating acute myocardial infarction: predictors of death. GUSTO Investigators. Global Utilization of Streptokinase and Tissue-Plasminogen Activator for Occluded Coronary Arteries". Am Heart J. 138 (1 Pt 1): 21–31. PMID 10385759.
- ↑ 18.0 18.1 Zeymer U, Vogt A, Zahn R, Weber MA, Tebbe U, Gottwik M; et al. (2004). "Predictors of in-hospital mortality in 1333 patients with acute myocardial infarction complicated by cardiogenic shock treated with primary percutaneous coronary intervention (PCI); Results of the primary PCI registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK)". Eur Heart J. 25 (4): 322–8. doi:10.1016/j.ehj.2003.12.008. PMID 14984921.
- ↑ Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD; et al. (1999). "Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock". N Engl J Med. 341 (9): 625–34. doi:10.1056/NEJM199908263410901. PMID 10460813.
- ↑ Shindler DM, Palmeri ST, Antonelli TA, Sleeper LA, Boland J, Cocke TP; et al. (2000). "Diabetes mellitus in cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK?". J Am Coll Cardiol. 36 (3 Suppl A): 1097–103. PMID 10985711.
- ↑ Holmes, D. R.; Berger, P. B.; Hochman, J. S.; Granger, C. B.; Thompson, T. D.; Califf, R. M.; Vahanian, A.; Bates, E. R.; Topol, E. J. (1999). "Cardiogenic Shock in Patients With Acute Ischemic Syndromes With and Without ST-Segment Elevation". Circulation. 100 (20): 2067–2073. doi:10.1161/01.CIR.100.20.2067. ISSN 0009-7322.
- ↑ Jacobs, Alice K; French, John K; Col, Jacques; Sleeper, Lynn A; Slater, James N; Carnendran, Louis; Boland, Jean; Jiang, Xianjiao; LeJemtel, Thierry; Hochman, Judith S (2000). "Cardiogenic shock with non-ST-segment elevation myocardial infarction: a report from the SHOCK Trial Registry". Journal of the American College of Cardiology. 36 (3): 1091–1096. doi:10.1016/S0735-1097(00)00888-3. ISSN 0735-1097.
- ↑ Klein LW, Shaw RE, Krone RJ, Brindis RG, Anderson HV, Block PC; et al. (2005). "Mortality after emergent percutaneous coronary intervention in cardiogenic shock secondary to acute myocardial infarction and usefulness of a mortality prediction model". Am J Cardiol. 96 (1): 35–41. doi:10.1016/j.amjcard.2005.02.040. PMID 15979429.
- ↑ Wong SC, Sleeper LA, Monrad ES, Menegus MA, Palazzo A, Dzavik V; et al. (2001). "Absence of gender differences in clinical outcomes in patients with cardiogenic shock complicating acute myocardial infarction. A report from the SHOCK Trial Registry". J Am Coll Cardiol. 38 (5): 1395–401. PMID 11691514.
- ↑ Antoniucci D, Migliorini A, Moschi G, Valenti R, Trapani M, Parodi G; et al. (2003). "Does gender affect the clinical outcome of patients with acute myocardial infarction complicated by cardiogenic shock who undergo percutaneous coronary intervention?". Catheter Cardiovasc Interv. 59 (4): 423–8. doi:10.1002/ccd.10573. PMID 12891599.