Abstract P130: Cardiogenic Shock Complicating Acute Coronary Syndromes: The Global Registry of Acute Coronary Events

Abstract

Introduction: Cardiogenic shock (CS) is the leading cause of death for patients with an acute coronary syndrome (ACS). Despite impressive advances in the management of ACS, the frequency of CS among patients hospitalized with an ACS has remained relatively constant over the past several decades, and mortality remains unduly high in these high risk patients. Objectives: To describe the characteristics, clinical management, and hospital outcomes of patients with an ACS complicated by CS. Our secondary objective was to describe decade long trends in the incidence and hospital case-fatality rates (CFRs) of CS, and predictors of increased hospital mortality in these patients. Methods: The study sample consisted of all patients enrolled in the Global Registry of Acute Coronary Events (GRACE) between 1999 and 2007 with a confirmed ACS. Results: Of all patients with ACS enrolled in GRACE, 2,992 (4.6%) developed CS. Compared to patients who did not develop CS, patients with CS were more likely to be older (mean age 71 vs. 65 years), female, have a history of diabetes or heart failure, and present with an ST-segment elevation. Cardiac catheterization was performed in 1,706(57%) patients and in-hospital revascularization in 1,408(47%) patients with CS. Patients with CS were less likely to receive effective cardiac medications as ACE inhibitors, aspirin and β-blockers compared to patients who did not develop CS. The in-hospital CFR of patients with CS was 59.4% compared to 2.3% in those who did not develop CS. Hospital CFR was lower for patients who underwent revascularization compared with those in whom a conservative medical approach was adopted (45% vs. 72%). Factors associated with an increased risk of in-hospital death in CS patients included advanced age, history of diabetes mellitus, heart failure and renal insufficiency. Adjusted incidence rates of CS showed slight significant annual decline over the study period (OR= 0.97, CI= 0.95 - 0.98) as well as in hospital CFRs (OR= 0.94, CI= 0.90 - 0.99), while in-hospital revascularization rates increased annually (OR= 1.09, CI= 1.06 - 1.12). Conclusion: Despite the increasing use of evidence-based therapies, the overall hospital CFR of CS remains high (59%) and incidence showed only slight declines between 1999 and 2007.