title: Improved outcome of cardiogenic shock at the acute stage of myocardial infarction: a report from the USIK 1995, USIC 2000, and FAST-MI French nationwide registries.
abstract: OBJECTIVE
  The historical evolution of incidence and outcome of cardiogenic shock (CS) in acute myocardial infarction (AMI) patients is debated. This study compared outcomes in AMI patients from 1995 to 2005, according to the presence of CS.
  
  
  RESULTS
  Three nationwide French registries were conducted 5 years apart, using a similar methodology in consecutive patients admitted over a 1-month period. All 7531 AMI patients presenting ≤48 h of symptom onset were included. The evolution of mortality was compared in the 486 patients with CS vs. those without CS. The incidence of CS tended to decrease over time (6.9% in 1995; 5.7% in 2005, P = 0.07). Thirty-day mortality was considerably higher in CS patients (60.9 vs. 5.2%). Over the 10-year period, mortality decreased for both patients with (70-51%, P = 0.003) and without CS (9-4%, P < 0.001). In CS patients, the use of percutaneous coronary intervention (PCI) increased from 20 to 50% (P < 0.001). Time period was an independent predictor of early mortality in CS patients (OR for death, 2005 vs. 1995 = 0.45; 95% CI: 0.27-0.75, P = 0.005), along with age, diabetes, and smoking status. When added to the multivariate model, PCI was associated with decreased mortality (OR = 0.38; 95% CI: 0.24-0.58, P < 0.001). In propensity-score-matched cohorts, CS patients with PCI had a significantly higher survival.
  
  
  CONCLUSIONS
  Cardiogenic shock remains a clinical concern, although early mortality has decreased. Improved survival is concomitant with a broader use of PCI and recommended medications at the acute stage. Beyond the acute stage, however, 1-year survival has remained unchanged.
authors.affiliation: Division of Coronary Artery Disease and Intensive Cardiac Care, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France. nadia.aissaoui@sat.aphp.fr
authors.forename: Nadia
authors.initials: N
authors.lastname: Aissaoui
authors.forename: Etienne
authors.initials: E
authors.lastname: Puymirat
authors.forename: Xavier
authors.initials: X
authors.lastname: Tabone
authors.forename: Bernard
authors.initials: B
authors.lastname: Charbonnier
authors.forename: Francois
authors.initials: F
authors.lastname: Schiele
authors.forename: Thierry
authors.initials: T
authors.lastname: Lefèvre
authors.forename: Eric
authors.initials: E
authors.lastname: Durand
authors.forename: Didier
authors.initials: D
authors.lastname: Blanchard
authors.forename: Tabassome
authors.initials: T
authors.lastname: Simon
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Cambou
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004812:Epidemiologic Methods; D005260:Female; D005602:France / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012770:Shock, Cardiogenic / Q000150:complications / Q000401:mortality* / Q000628:therapy; D055815:Young Adult