title: Gradual decline in the age-adjusted in-hospital mortality rate from STEMI-related cardiogenic shock irrespective of cause, race or gender with persistent higher mortality rates in women despite multivariate adjustment.
abstract: BACKGROUND
  Recent improvements in the care of critically ill patients with cardiogenic shock (CS) should be associated with improved outcomes. The goal of this study was to evaluate the trends of age-adjusted mortality rates for all-cause and ST-elevation myocardial infarction (STEMI)-related CS in the United States.
  
  
  METHODS
  The Nationwide Inpatient Sample (NIS) database was utilized to calculate the age-adjusted mortality rate of all-cause and STEMI-related CS from 1996 to 2006. We used specific ICD- 9 codes for CS and STEMI based on race and gender.
  
  
  RESULTS
  We found a gradual decrease in mortality over the 10-year period in patients suffering from all causes or STEMI-related CS irrespective of gender and race with a persistently higher mortality rates in women and African Americans. However, after multivariate adjustment, only female gender remains associated with persistently higher mortality. The age-adjusted mortality rate from STEMI-related CS in women was 2.2% in 1996, with a gradual reduction to the lowest level of 1.7% in 2006 (P<.01). Likewise, the age-adjusted mortality rate from STEMI-related CS in men was 1.7% in 1996, which declined to the lowest level of 1.4% in 2006 (P<.01).
  
  
  CONCLUSIONS
  Regardless of gender and race, age-adjusted in-hospital mortality is gradually declining in patients presenting with all causes or STEMI-related CS. However, as compared to men, women suffer from persistently higher mortality rates in the setting of STEMI-related CS despite multivariate adjustment.
authors.affiliation: University of Arizona Sarver Heart Center, 7091 E. Speedway Blvd, Tucson, AZ 85710 USA. rmova@aol.com.
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Movahed
authors.forename: Muhammad F
authors.initials: MF
authors.lastname: Khan
authors.forename: Mehrtash
authors.initials: M
authors.lastname: Hashemzadeh
authors.forename: Mehrnoosh
authors.initials: M
authors.lastname: Hashemzadeh
mesh_terms: D001741:Black or African American / Q000208:ethnology / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004562:Electrocardiography; D019317:Evidence-Based Medicine; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis; D011379:Prognosis; D044469:Racial Groups; D012189:Retrospective Studies; D012737:Sex Factors; D012770:Shock, Cardiogenic / Q000208:ethnology / Q000209:etiology* / Q000401:mortality*; D015996:Survival Rate; D014481:United States; D044465:White People / Q000208:ethnology / Q000706:statistics & numerical data