Trends in Incidence, Management, and Outcomes of Cardiogenic Shock Complicating ST‐Elevation Myocardial Infarction in the United States

Abstract

Background: Limited information is available on the contemporary and potentially changing trends in the incidence, management, and outcomes of cardiogenic shock complicating ST ‐elevation myocardial infarction ( STEMI ). Methods and Results: We queried the 2003–2010 Nationwide Inpatient Sample databases to identify all patients ≥40 years of age with STEMI and cardiogenic shock. Overall and age‐, sex‐, and race/ethnicity‐specific trends in incidence of cardiogenic shock, early mechanical revascularization, and intra‐aortic balloon pump use, and inhospital mortality were analyzed. From 2003 to 2010, among 1 990 486 patients aged ≥40 years with STEMI , 157 892 (7.9%) had cardiogenic shock. The overall incidence rate of cardiogenic shock in patients with STEMI increased from 6.5% in 2003 to 10.1% in 2010 ( P trend <0.001). There was an increase in early mechanical revascularization (30.4% to 50.7%, P trend <0.001) and intra‐aortic balloon pump use (44.8% to 53.7%, P trend <0.001) in these patients over the 8‐year period. Inhospital mortality decreased significantly, from 44.6% to 33.8% ( P trend <0.001; adjusted OR , 0.71; 95% CI , 0.68 to 0.75), whereas the average total hospital cost increased from $35 892 to $45 625 ( P trend <0.001) during the study period. There was no change in the average length of stay ( P trend =0.394). These temporal trends were similar in patients <75 and ≥75 years of age, men and women, and across each racial/ethnic group. Conclusions: The incidence of cardiogenic shock complicating STEMI has increased during the past 8 years together with increased use of early mechanical revascularization and intra‐aortic balloon pumps. There has been a concomitant decrease in risk‐adjusted inhospital mortality, but an increase in total hospital costs during this period.