title: Trends in incidence, management, and outcomes of cardiogenic shock complicating ST-elevation myocardial infarction in the United States.
abstract: BACKGROUND
  Limited information is available on the contemporary and potentially changing trends in the incidence, management, and outcomes of cardiogenic shock complicating ST-elevation myocardial infarction (STEMI).
  
  
  RESULTS
  We queried the 2003-2010 Nationwide Inpatient Sample databases to identify all patients ≥ 40 years of age with STEMI and cardiogenic shock. Overall and age-, sex-, and race/ethnicity-specific trends in incidence of cardiogenic shock, early mechanical revascularization, and intra-aortic balloon pump use, and inhospital mortality were analyzed. From 2003 to 2010, among 1 990 486 patients aged ≥ 40 years with STEMI, 157 892 (7.9%) had cardiogenic shock. The overall incidence rate of cardiogenic shock in patients with STEMI increased from 6.5% in 2003 to 10.1% in 2010 (P(trend)<0.001). There was an increase in early mechanical revascularization (30.4% to 50.7%, P(trend)<0.001) and intra-aortic balloon pump use (44.8% to 53.7%, P(trend)<0.001) in these patients over the 8-year period. Inhospital mortality decreased significantly, from 44.6% to 33.8% (P(trend)<0.001; adjusted OR, 0.71; 95% CI, 0.68 to 0.75), whereas the average total hospital cost increased from $35 892 to $45 625 (P(trend)<0.001) during the study period. There was no change in the average length of stay (P(trend)=0.394). These temporal trends were similar in patients <75 and ≥ 75 years of age, men and women, and across each racial/ethnic group.
  
  
  CONCLUSIONS
  The incidence of cardiogenic shock complicating STEMI has increased during the past 8 years together with increased use of early mechanical revascularization and intra-aortic balloon pumps. There has been a concomitant decrease in risk-adjusted inhospital mortality, but an increase in total hospital costs during this period.
authors.affiliation: Department of Medicine, New York Medical College, Valhalla, NY.
authors.forename: Dhaval
authors.initials: D
authors.lastname: Kolte
authors.forename: Sahil
authors.initials: S
authors.lastname: Khera
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
authors.forename: Marjan
authors.initials: M
authors.lastname: Mujib
authors.forename: Chandrasekar
authors.initials: C
authors.lastname: Palaniswamy
authors.forename: Sachin
authors.initials: S
authors.lastname: Sule
authors.forename: Diwakar
authors.initials: D
authors.lastname: Jain
authors.forename: William
authors.initials: W
authors.lastname: Gotsis
authors.forename: Ali
authors.initials: A
authors.lastname: Ahmed
authors.forename: William H
authors.initials: WH
authors.lastname: Frishman
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D017721:Hospital Costs / Q000639:trends; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007423:Intra-Aortic Balloon Pumping / Q000191:economics / Q000639:trends*; D007902:Length of Stay / Q000639:trends; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D009204:Myocardial Revascularization / Q000191:economics / Q000639:trends*; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000639:trends*; D044469:Racial Groups; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: ST‐elevation myocardial infarction; cardiogenic shock; early revascularization; inhospital mortality; trends