Trends in cardiogenic shock: report from the SHOCK Study

Aims We analysed time trends in patient characteristics, management, and ou tcomes of cardiogenic shock complicating acute myocardial infarction in the international, prospective SHOCK Trial Registry and pre-study Registry. Background Despite therapeutic advances in its management, the incidence an d high mortality of this complication has remained unchanged for decades. H owever, in recent years mortality was reported to decrease in one community concomitant with increasing use of revascularization. Methods Thirty-six centres registered 1380 patients with suspected cardioge nic shock complicating acute myocardial infarction from January 1992 to Aug ust 1997. Patient and myocardial infarction characteristics, haemodynamics, medications, procedure use, and vital status at discharge were recorded. Results In all, 79% of patients had shock due to predominant pump failure ( non-mechanical aetiology). The aetiology, patient profile, and clinical cha racteristics of cardiogenic shock did not differ over time, except for incr eases in the incidence of prior bypass surgery (P=0.054) and transfers to t ertiary centres (P=0.008). In all, 44% underwent revascularization (n=485), with angioplasty performed more often than bypass surgery (69% vs 31%). Th e revascularization rate increased over time (P=0.006) with a significant d ecrease in the time to revascularization (P=0.033). The use of Swan-Ganz ca theterization decreased over time (P=0.018), as did the mean length of hosp italization (P=0.034). Overall in-hospital mortality was high (63%) but dec reased over time in all patients (P=0.004) and those with pump failure (P=0 .018). Mortality was lower for patients who underwent revascularization com pared to those who were not revascularized (41% vs 79%, P<0.001). Conclusions Cardiogenic shock complicating acute myocardial infarction is a ssociated with a high mortality rate, but mortality decreased significantly from 1992 to 1997. This partly reflects the greater use of revascularizati on, which was associated with better outcomes. The reported international t rend towards shorter admissions for myocardial infarction was also observed in this cohort. (C)) 2001 The European Society of Cardiology.