Abstract
IntroductionThere are little data about patients with cardiogenic shock (CS) who survive the early phase of acute myocardial infarction (AMI). The aim of this study was to assess long-term (5-year) mortality among early survivors of AMI, according to the presence of CS at the acute stage.MethodsWe analyzed 5-year follow-up data from the French registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) 2005 registry, a nationwide French survey including consecutive patients admitted for ST or non-ST-elevation AMI at the end of 2005 in 223 institutions.ResultsOf 3670 patients enrolled, shock occurred in 224 (6.1%), and 3411 survived beyond 30 days or hospital discharge, including 99 (2.9%) with shock. Early survivors with CS had a more severe clinical profile, more frequent concomitant in-hospital complications, and were less often managed invasively than those without CS.Five-year survival was 59% in patients with, versus 76% in those without shock (adjusted hazard ratio (HR) = 1.72 [1.24-2.38], P = 0.001). The excess of death associated with CS, however, was observed only during the first year (one-year survival: 77% vs 93%, adjusted HR: 2.87 [1.85 to 4.46] P <0.001), while survival from one to 5 years was similar (76% vs 82%, adjusted HR: 1.06 [0.64 to 1.74]). Propensity score-matched analyses yielded similar results.ConclusionsIn patients surviving the early phase of AMI, CS at the initial stage carries an increased risk of death up to one year after the acute event. Beyond one year, however, mortality is similar to that of patients without shock.Trial registrationClinicalTrials.gov number, NCT00673036, Registered May 5, 2008.
Highlights
There are little data about patients with cardiogenic shock (CS) who survive the early phase of acute myocardial infarction (AMI)
Despite considerable progress in the management of patients admitted for acute myocardial infarction (AMI), cardiogenic shock (CS) remains a major complication [1,2]
Landmark analyses in the overall population One-year survival was 93% in early survivors without CS and 77% in patients with CS
Summary
There are little data about patients with cardiogenic shock (CS) who survive the early phase of acute myocardial infarction (AMI). In-hospital mortality has declined due to early revascularization and improved overall management, Little data exist on the long-term outcomes of patients surviving the acute phase of CS following AMI [4,5,6]. The French registry of Acute ST-elevation and nonST-elevation Myocardial Infarction (FAST MI) 2005 registry is a prospective, nationwide, observational study conducted at the end of 2005 in a large number of the French hospitals treating AMI patients [7,8]. It allows evaluation of the long-term outcome in acute ST-elevation and non-ST-elevation myocardial infarction patients with and without CS. The aim of the present study was to analyse long-term outcomes of early survivors of the acute phase, according to the presence of CS at the acute stage
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