Leonardo De Luca1, Zoran Olivari2, Andrea Farina3, Lucio Gonzini4, Donata Lucci4, Antonio Di Chiara5, Gianni Casella6, Francesco Chiarella7, Alessandro Boccanelli8, Giuseppe Di Pasquale6, Stefano De Servi9, Francesco Maria Bovenzi10, Michele Massimo Gulizia11, Stefano Savonitto3. 1. Department of Cardiovascular Sciences, European Hospital, Rome, Italy. 2. Department of Cardiology, Ca' Foncello Hospital, Treviso, Italy. 3. Division of Cardiology, Ospedale A. Manzoni, Lecco, Italy. 4. ANMCO Research Center, Florence, Italy. 5. Division of Cardiology, Ospedale San Antonio Abate, Tolmezzo, Italy. 6. Department of Cardiology, Maggiore Hospital, Bologna, Italy. 7. Division of Cardiology, Azienda Ospedaliera-Universitaria, S. Martino, Genova, Italy. 8. Department of Cardiovascular Diseases, S. Giovanni-Addolorata Hospital, Rome, Italy. 9. Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. 10. Cardiology Division, Campo di Marte Hospital, Lucca, Italy. 11. Division of Cardiology, Garibaldi-Nesima Hospital, Catania, Italy.
Abstract
AIMS: Despite advances in the management of patients with acute coronary syndrome (ACS), cardiogenic shock (CS) remains the leading cause of death in these patients. We describe the evolution of clinical characteristics, in-hospital management, and outcome of patients with CS complicating ACS. METHODS AND RESULTS: We analysed data from five Italian nationwide prospective registries, conducted between 2001 and 2014, including consecutive patients with ACS. Out of 28 217 ACS patients enrolled, 1209 (4.3%) had CS: 526 (44%) at the time of admission and 683 (56%) later on during hospitalization. Over the years, a reduction in the incidence of CS was observed, even though this was not statistically significant (P for trend = 0.17). The proportions of CS patients with a history of heart failure declined, whereas the proportion of those with hypertension, renal dysfunction, previous PCI, and AF significantly increased. The use of PCI considerably increased from 2001 to 2014 [19% to 60%; percentage change 41, 95% confidence interval (CI) 29-51]. In-hospital mortality of CS patients decreased from 68% (95% CI 59-76) in 2001 to 38% (95% CI 29-47) in 2014 (percentage change -30, 95% CI -41 to -18). Compared with 2001, the risk of death was significantly lower in all of the registries, with reductions in adjusted mortality between 45% and 66%. CONCLUSIONS: Over the last 14 years, substantial changes occurred in the clinical characteristics and management of patients with CS complicating ACS, with a greater use of PCI and a significant reduction in adjusted mortality rate.
AIMS: Despite advances in the management of patients with acute coronary syndrome (ACS), cardiogenic shock (CS) remains the leading cause of death in these patients. We describe the evolution of clinical characteristics, in-hospital management, and outcome of patients with CS complicating ACS. METHODS AND RESULTS: We analysed data from five Italian nationwide prospective registries, conducted between 2001 and 2014, including consecutive patients with ACS. Out of 28 217 ACS patients enrolled, 1209 (4.3%) had CS: 526 (44%) at the time of admission and 683 (56%) later on during hospitalization. Over the years, a reduction in the incidence of CS was observed, even though this was not statistically significant (P for trend = 0.17). The proportions of CS patients with a history of heart failure declined, whereas the proportion of those with hypertension, renal dysfunction, previous PCI, and AF significantly increased. The use of PCI considerably increased from 2001 to 2014 [19% to 60%; percentage change 41, 95% confidence interval (CI) 29-51]. In-hospital mortality of CS patients decreased from 68% (95% CI 59-76) in 2001 to 38% (95% CI 29-47) in 2014 (percentage change -30, 95% CI -41 to -18). Compared with 2001, the risk of death was significantly lower in all of the registries, with reductions in adjusted mortality between 45% and 66%. CONCLUSIONS: Over the last 14 years, substantial changes occurred in the clinical characteristics and management of patients with CS complicating ACS, with a greater use of PCI and a significant reduction in adjusted mortality rate.
Authors: Brian Y Chang; Steven P Keller; Sonya S Bhavsar; Noam Josephy; Elazer R Edelman Journal: Sci Transl Med Date: 2018-02-28 Impact factor: 17.956
Authors: Julia Schumann; Eva C Henrich; Hellen Strobl; Roland Prondzinsky; Sophie Weiche; Holger Thiele; Karl Werdan; Stefan Frantz; Susanne Unverzagt Journal: Cochrane Database Syst Rev Date: 2018-01-29
Authors: Leonardo De Luca; Marco Marini; Lucio Gonzini; Alessandro Boccanelli; Gianni Casella; Francesco Chiarella; Stefano De Servi; Antonio Di Chiara; Giuseppe Di Pasquale; Zoran Olivari; Giorgio Caretta; Laura Lenatti; Michele Massimo Gulizia; Stefano Savonitto Journal: J Am Heart Assoc Date: 2016-11-23 Impact factor: 5.501
Authors: Konstantin Uhlig; Ljupcho Efremov; Jörn Tongers; Stefan Frantz; Rafael Mikolajczyk; Daniel Sedding; Julia Schumann Journal: Cochrane Database Syst Rev Date: 2020-11-05