title: [Acute myocardial infarction complicated by cardiogenic shock: what changed over a 10-year time span?].
abstract: BACKGROUND
  Despite improvements in treatment, mortality associated with cardiogenic shock (CS) following acute myocardial infarction remains high.
  
  
  OBJECTIVE
  To compare two groups of patients admitted with CS over a 10-year time span.
  
  
  METHODS
  We performed a retrospective analysis of two patient populations presenting with CS admitted in the periods May 1998-May 2001 (group A) and May 2008-May 2011 (group B). Clinical characteristics, diagnostic methods, treatment and outcomes were compared, and independent predictors of death at six months were analyzed.
  
  
  RESULTS
  The incidence of CS was 3.7% in group A (n=25) and 4.8% in group B (n=42). There were no significant differences in clinical characteristics except for age (60.2±12.3 vs. 66.5±11.3 years; p=0.043) and the proportion of patients admitted within six hours of symptom onset (29.2% vs. 54.8%, p=0.045). There was a reduction in use of pulmonary artery catheterization (52.0% vs. 19.0%, p=0.005) but an increase in dialysis (4.0% vs. 28.6%, p=0.014). There was no difference in the proportion of patients reperfused within 12 hours or revascularized, but use of percutaneous coronary intervention (PCI) increased (75.0% vs. 92.9%, p=0.042). There were no differences in outcomes, including mortality at 30 days (32.0 vs. 35.7%; p=0.757) and six months (36.0 vs. 42.9%; p=0.683). Diabetes was the sole baseline characteristic identified as an independent predictor of death at six months (hazard ratio [HR] 3.02; 95% confidence interval [CI] 1.38-6.60; p=0.006) and mortality was lower among revascularized patients (HR 0.11; 95% CI 0.03-0.42; p=0.001).
  
  
  CONCLUSIONS
  Over a 10-year time span, despite earlier hospital admission and increased use of support therapies and PCI, short- and medium-term mortality remained unchanged.
authors.affiliation: Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal. Electronic address: heldores@hotmail.com.
authors.forename: Hélder
authors.initials: H
authors.lastname: Dores
authors.forename: Jorge
authors.initials: J
authors.lastname: Ferreira
authors.forename: Francisco
authors.initials: F
authors.lastname: Costa
authors.forename: Carlos
authors.initials: C
authors.lastname: Aguiar
authors.forename: Gonçalo
authors.initials: G
authors.lastname: Cardoso
authors.forename: Rui
authors.initials: R
authors.lastname: Teles
authors.forename: Pedro de Araújo
authors.initials: Pde A
authors.lastname: Gonçalves
authors.forename: Luís
authors.initials: L
authors.lastname: Raposo
authors.forename: Marisa
authors.initials: M
authors.lastname: Trabulo
authors.forename: Manuel de Sousa
authors.initials: Mde S
authors.lastname: Almeida
authors.forename: José Pedro
authors.initials: JP
authors.lastname: Neves
authors.forename: Miguel
authors.initials: M
authors.lastname: Mendes
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology*; D013997:Time Factors
keywords: Acute myocardial infarction; Cardiogenic shock; Choque cardiogénico; Enfarte agudo do miocárdio; Falência ventricular esquerda; Left ventricular pump failure; Myocardial revascularization; Revascularização miocárdica