0111: Evolution of incidence and one-year outcomes of cardiogenic shock in acute myocardial infarction from 1995 to 2010. The FAST-MI programme

Abstract

Cardiogenic shock (CS) at the acute stage of MI remains a major concern. Information on its incidence over the past 20 years is discrepant, and little is known of the evolution of long-term mortality over the years. We analysed the incidence and one-year mortality of CS in 4 nationwide French survey carried out 5 years apart from 1995 to 2010. Consecutive STEMI and NSTEMI patients (≤48 hours from onset) were recruited over one-month periods. Among 10610 patients included in the 4 surveys, 614 (5.8%) had CS. Incidence of CS decreased (6.9% in 1995; 4.0% in 2010, p<0.001), both for STEMI and NSTEMI. Pts with CS were older than those without (74±12 vs 66±14y); mean age of CS pts remained unchanged. In CS pts, use of PCI increased from 20% to 73%, and in STEMI patients with CS, reperfusion therapy increased from 40% to 72%. Thirty-day mortality (56.2% vs 4.3%) and one-year mortality (66.6% vs 10.3%) were considerably higher in CS pts. Over the 15-year period, one-year mortality decreased for both pts with (75% to 51%, P<0.001) and without CS (15% to 7%, P<0.001). By Cox multivariate analysis in the whole population, both time period and presence of CS were independent predictors of one-year mortality. In CS pts, age, diabetes, higher BMI and type of MI (STEMI), were independent correlates of increased one-year death, while time period was associated with reduced mortality (HR:2010 vs 1995=0.57; 95% CI: 0.40-0.83, along with early use of PCI and medications at the acute stage. In these 4 nationwide surveys conducted 15 years apart, the incidence of CS decreased and one-year mortality of CS patients significantly decreased. Although improved survival was associated with a broader use of PCI and appropriate medications at the acute stage, the fact that time period remained an independent predictor of improved outcomes suggests improved overall process of care.