Temporal trends in cardiogenic shock complicating acute myocardial infarction

Background Limited information is available on trends in the incidence of a nd mortality due to cardiogenic shock complicating acute myocardial infarct ion. We studied the incidence of cardiogenic shock complicating acute myoca rdial infarction and in-hospital death rates among patients with this condi tion in a single community from 1975 through 1997. Methods We conducted an observational study of 9076 residents of metropolit an Worcester, Massachusetts, who were hospitalized with confirmed acute myo cardial infarction in all local hospitals during 11 one-year periods betwee n 1975 and 1997. Our study included periods before and after the advent of reperfusion therapy. Results The incidence of cardiogenic shock remained relatively stable over time, averaging 7.1 percent among patients with acute myocardial infarction . The results of a multivariable regression analysis indicated that the pat ients hospitalized during recent study years were not at a substantially lo wer risk for shock than patients hospitalized in the mid-to-late 1970s. Pat ients in whom cardiogenic shock developed had a significantly greater risk of dying during hospitalization (71.7 percent) than those who did not have cardiogenic shock (12.0 percent, P<0.001). A significant trend toward an in crease in in-hospital survival among patients with cardiogenic shock in the mid-to-late 1990s was found in crude and adjusted analyses. Conclusions Our findings indicate no significant change in the incidence of cardiogenic shock complicating acute myocardial infarction over a 23-year period. However, the short-term survival rate has increased in recent years at the same time as the use of coronary reperfusion strategies has increas ed. (N Engl J Med 1999;340:1162-8.) (C)1999, Massachusetts Medical Society.