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Ten-Year Trends in the Incidence and Treatment of Cardiogenic Shock

Raban V. Jeger, MD; Dragana Radovanovic, MD, MSc; Patrick R. Hunziker, MD; Matthias E. Pfisterer, MD; Jean-Christophe Stauffer, MD; Paul Erne, MD; Philip Urban, MD, AMIS Plus Registry Investigators
[+] Article, Author, and Disclosure Information

From University Hospital Basel, Basel; University of Zurich, Zurich; University Hospital Lausanne, Lausanne; Cantonal Hospital Lucerne, Lucerne; and La Tour Hospital, Geneva, Switzerland.

Grant Support: The AMIS Plus Registry project was supported by the following sources (all in Switzerland; grouped by city rather than by grant size or any other preferential factor): Swiss Heart Foundation and Novartis Pharma Schweiz, Bern; A. Menarini, Bayer (Schweiz), Pfizer, SPSS (Schweiz), and St. Jude Medical, Zurich; AstraZeneca, Zug; Biotronik Schweiz, Bristol-Myers Squibb, and Schering, Baar; Boehringer Ingelheim (Schweiz), Basel; Boston Scientific, Solothurn; Cordis, Johnson & Johnson, Spreitenbach; GlaxoSmithKline, Mnchenbuchsee; Invatec, Schaffhausen; Medtronic Schweiz, Tolochenaz; MCM medsys, Kirchberg; Merck Sharp & Dohme Chibret, Opfikon-Glattbrugg; Nycomed Pharma, Dbendorf; Sanofi-Aventis (Suisse) and Servier (Suisse), Meyrin; and Takeda Pharma, Lachen, Switzerland.

Potential Financial Conflicts of Interest: None disclosed.

Reproducible Research Statement:Study protocol: Case report form available at http://www.amis-plus.ch. Statistical code: Available from Dr. Radovanovic (e-mail, dragana@ifspm.uzh.ch). Data set: Not available.

Requests for Single Reprints: Philip Urban, MD, Cardiovascular Department, La Tour Hospital, Avenue Maillard 1, 1217 Meyrin-Geneva, Switzerland; e-mail, philip.urban@latour.ch.

Current Author Addresses: Drs. Jeger and Pfisterer: Cardiology, University Hospital, Petersgraben 4, CH-4031 Basel, Switzerland.

Dr. Radovanovic: AMIS Plus Data Center, Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, CH-8001 Zurich, Switzerland.

Dr. Hunziker: Medical Intensive Care Unit, University Hospital, Petersgraben 4, CH-4031 Basel, Switzerland.

Dr. Stauffer: Cardiology, University Hospital, Rue du Bugnon 46, CH-1101 Lausanne, Switzerland.

Dr. Erne: Cardiology, Cantonal Hospital, CH-6000 Lucerne 16, Switzerland.

Dr. Urban: Cardiovascular Department, La Tour Hospital, Avenue Maillard 1, 1217 Meyrin-Geneva, Switzerland.

Author Contributions: Conception and design: R.V. Jeger, P.R. Hunziker.

Analysis and interpretation of the data: R.V. Jeger, D. Radovanovic, M.E. Pfisterer, J.C. Stauffer.

Drafting of the article: R.V. Jeger, P.R. Hunziker.

Critical revision of the article for important intellectual content: D. Radovanovic, P.R. Hunziker, M.E. Pfisterer, J.C. Stauffer.

Final approval of the article: R.V. Jeger, D. Radovanovic, P.R. Hunziker, M.E. Pfisterer, J.C. Stauffer.

Provision of study materials or patients: P.R. Hunziker, J.C. Stauffer.

Statistical expertise: R.V. Jeger.

Administrative, technical, or logistic support: R.V. Jeger, P.R. Hunziker.

Collection and assembly of data: P.R. Hunziker.

Ann Intern Med. 2008;149(9):618-626. doi:10.7326/0003-4819-149-9-200811040-00005
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In this analysis of a large, population-based registry covering 10 years of observation, rates of cardiogenic shock on admission remained constant, whereas the incidence of cardiogenic shock as a complication of ACS steadily decreased over time because fewer patients in recent years developed cardiogenic shock during hospitalization. Although rates of PCI and intra-aortic balloon counterpulsation use in cardiogenic shock increased to greater than 60% and greater than 30%, respectively, mortality decreased to less than 50% in all subgroups. However, this decrease was not statistically significant in the subgroup of patients with cardiogenic shock developing during hospitalization. Similarly, use of antithrombotic and anti-ischemic drug therapy increased over time. Both PCI and lipid-lowering treatment were associated with lower mortality rates among all patients with ACS and with lower rates of cardiogenic shock development during hospitalization among patients with ACS without cardiogenic shock on admission.

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Figure 2.
Temporal trends from 1997 to 2006 in the incidence of overall cardiogenic shock (CS), CS on admission, and CS developing during hospitalization in patients with the acute coronary syndrome.
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Figure 3.
Temporal trends from 1997 to 2006 in the frequency of percutaneous coronary intervention, coronary artery bypass graft surgery, fibrinolytic therapy, and intra-aortic balloon counterpulsation in patients with cardiogenic shock.
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Figure 4.
Temporal trends from 1997 to 2006 in rates of death in patients with overall cardiogenic shock, cardiogenic shock on admission, and cardiogenic shock developing during hospitalization.
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