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Title: Outcomes of cardiogenic shock complicating acute coronary syndromes.
Austin Authors: Noaman, Samer;Andrianopoulos, Nick;Brennan, Angela L;Dinh, Diem;Reid, Christopher;Stub, Dion;Biswas, Sinjini;Clark, David J ;Shaw, James;Ajani, Andrew;Freeman, Melanie;Yip, Thomas;Oqueli, Ernesto;Walton, Antony;Duffy, Stephen J;Chan, William
Affiliation: Cardiology
Monash University, Melbourne, Victoria, Australia
Department of Cardiology, Ballarat Health Services, Ballarat, Victoria, Australia
Department of Cardiology, Geelong University Hospital, Geelong, Victoria, Australia
Department of Cardiology, Box Hill Hospital, Melbourne, Victoria, Australia
Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia
Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
Clinical Research Domain, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
School of Public Health, Curtin University, Perth, Western Australia, Australia
Issue Date: Sep-2020
Date: 2020-02-03
Publication information: Catheterization and Cardiovascular Interventions 2020; 96(3): E257-E267
Abstract: We aimed to assess the outcomes of cardiogenic shock (CS) complicating acute coronary syndromes (ACS). CS remains the leading cause of mortality in patients presenting with ACS despite advances in care. We studied 13,184 patients undergoing percutaneous coronary intervention (PCI) for all subtypes of ACS enrolled prospectively in a large multicentre Australian registry (Melbourne Interventional Group registry) from 2005 to 2013. All-cause mortality was obtained via linkage to the National Death Index. Patients were divided into those with and those without CS. Compared to the non-CS group (n = 12,548, 95.2%), the CS group (n = 636, 4.8%) had a higher proportion of out-of-hospital cardiac arrest (OHCA) (31.1 vs. 2.2%) and ST-elevation myocardial infarction (STEMI) presentation (89 vs. 34%), both p < .01. Patients in the CS group had higher rates of in-hospital (40.4 vs. 1.2%) and 30-day (41 vs. 1.7%) mortality compared to the non-CS group. Long-term mortality over a median follow-up of 4.2 years was higher in the CS group (50.6 vs. 13.8%), p < .001. Trends of in-hospital and 30-day mortality rates of CS complicating ACS were relatively stable from 2005 to 2013. Predictors of long-term NDI-linked mortality within the CS group include severe left ventricular systolic dysfunction (HR 3.0), glomerular filtration rate (GFR) <30 (HR 2.56), GFR 30-59 (HR 1.94), OHCA (HR 1.46), diabetes (HR 1.44), and age (HR 1.02), all p < .05. Rates of CS-related mortality complicating ACS have remained very high and steady over nearly a decade despite progress in STEMI systems of care, PCI techniques, and medical therapy.
DOI: 10.1002/ccd.28759
ORCID: 0000-0002-8760-5373
Journal: Catheterization and Cardiovascular Interventions
PubMed URL: 32017332
Type: Journal Article
Subjects: acute myocardial infarction/STEMI
heart failure
percutaneous coronary intervention
Appears in Collections:Journal articles

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