Temporal trends in the epidemiology, management, and outcome of patients with cardiogenic shock complicating acute coronary syndromes.
OBJECTIVE
Despite advances in the management of patients with acute coronary syndrome (ACS), cardiogenic shock (CS) remains the leading cause of death in these patients. We describe the evolution of clinical characteristics, in-hospital management, and outcome of patients with CS complicating ACS.


RESULTS
We analysed data from five Italian nationwide prospective registries, conducted between 2001 and 2014, including consecutive patients with ACS. Out of 28 217 ACS patients enrolled, 1209 (4.3%) had CS: 526 (44%) at the time of admission and 683 (56%) later on during hospitalization. Over the years, a reduction in the incidence of CS was observed, even though this was not statistically significant (P for trend = 0.17). The proportions of CS patients with a history of heart failure declined, whereas the proportion of those with hypertension, renal dysfunction, previous PCI, and AF significantly increased. The use of PCI considerably increased from 2001 to 2014 [19% to 60%; percentage change 41, 95% confidence interval (CI) 29-51]. In-hospital mortality of CS patients decreased from 68% (95% CI 59-76) in 2001 to 38% (95% CI 29-47) in 2014 (percentage change -30, 95% CI -41 to -18). Compared with 2001, the risk of death was significantly lower in all of the registries, with reductions in adjusted mortality between 45% and 66%.


CONCLUSIONS
Over the last 14 years, substantial changes occurred in the clinical characteristics and management of patients with CS complicating ACS, with a greater use of PCI and a significant reduction in adjusted mortality rate.
Department of Cardiovascular Sciences, European Hospital, Rome, Italy.
Leonardo
L
De Luca
Department of Cardiology, Ca' Foncello Hospital, Treviso, Italy.
Zoran
Z
Olivari
Division of Cardiology, Ospedale A. Manzoni, Lecco, Italy.
Andrea
A
Farina
ANMCO Research Center, Florence, Italy.
Lucio
L
Gonzini
ANMCO Research Center, Florence, Italy.
Donata
D
Lucci
Division of Cardiology, Ospedale San Antonio Abate, Tolmezzo, Italy.
Antonio
A
Di Chiara
Department of Cardiology, Maggiore Hospital, Bologna, Italy.
Gianni
G
Casella
Division of Cardiology, Azienda Ospedaliera-Universitaria, S. Martino, Genova, Italy.
Francesco
F
Chiarella
Department of Cardiovascular Diseases, S. Giovanni-Addolorata Hospital, Rome, Italy.
Alessandro
A
Boccanelli
Department of Cardiology, Maggiore Hospital, Bologna, Italy.
Giuseppe
G
Di Pasquale
Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Stefano
S
De Servi
Cardiology Division, Campo di Marte Hospital, Lucca, Italy.
Francesco Maria
FM
Bovenzi
Division of Cardiology, Garibaldi-Nesima Hospital, Catania, Italy.
Michele Massimo
MM
Gulizia
Division of Cardiology, Ospedale A. Manzoni, Lecco, Italy.
Stefano
S
Savonitto
D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data / Q000639:trends; D017023:Coronary Angiography / Q000706:statistics & numerical data; D019468:Disease Management; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012042:Registries; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy; D062211:Spatio-Temporal Analysis
Acute coronary syndromes; Cardiogenic shock; Percutaneous coronary intervention; Registries; Trends