Cardiogenic shock after acute myocardial infarction: incidence and mortality from a community-wide perspective, 1975 to 1988

Article Abstract:

To learn more about the outcome of cardiogenic shock after acute myocardial infarction (heart attack), this study assessed patients admitted to 16 teaching and community hospitals near Worcester, Massachusetts. Cardiogenic shock is an often-fatal condition that occurs as a result of a sudden, severe decrease in cardiac output, which leads to constriction of blood vessels, decreased urine output, and dramatic decreases in tissue perfusion (decreased blood and oxygen supply to tissues). Medical records were reviewed from 4,762 patients hospitalized with acute myocardial infarction for the years 1975, 1978, 1981, 1984, 1986, and 1988. The incidence, characteristics, and outcome of cardiogenic shock were determined. This condition was said to exist in the presence of normal blood volume when the systolic blood pressure fell below 80 millimeters of mercury (mm Hg) and certain other signs (cyanosis, cold extremities, congestive heart failure) were observed. Results showed a constant incidence for cardiogenic shock (7.5 percent) in all the years studied. The yearly incidences varied in an inconsistent way; that is, the incidence for 1988 was 9.1 percent; for 1986, 7.6 percent; and for 1984, 6.7 percent. Heart attach patients who developed cardiogenic shock tended to be older and female. Patients with recurrent infarctions, infarctions of a Q-wave type, and more extensive infarctions were also more likely to develop cardiogenic shock. Slightly more than 77 percent of the patients with cardiogenic shock died, compared with 13.5 percent of those who did not develop it. The short-term survival of patients with this complication grew worse between 1975 and 1988. Additional follow-up showed that patients who survived cardiogenic shock during hospitalization had poorer long-term survival than those who never experienced it. A discussion is presented of the effectiveness of various approaches for treating cardiogenic shock. It is possible that wider use of newer methods of treating myocardial infarction, such as thrombolytic therapy (clot-dissolving drugs), would improve these rather grim statistics. (Consumer Summary produced by Reliance Medical Information, Inc.)

Reports, Medical statistics

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Temporal trends in cardiogenic shock complicating acute myocardial infarction

Article Abstract:

Some people who have a heart attack develop cardiogenic shock but their prognosis in the late 1990s is better than it was in the 1970s. Cardiogenic shock occurs when the heart begins to fail and can lead to death. Researchers analyzed the rate of cardiogenic shock in heart attack patients between 1975 and 1997. The rate remained stable during this time at 7% of all heart attack patients. Seventy-two percent of the patients in cardiogenic shock died compared to 12% of those not in cardiogenic shock. Short-term survival rates increased during the 1990s, probably because of the use of thrombolytic drugs to restore blood flow.

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A validated prediction model for all forms of acute coronary syndrome

Article Abstract:

A simple decision tool for bedside risk estimation of 6-month mortality in patients surviving admission for an acute coronary syndrome (ACS) is developed. The Global Registry of Acute Coronary Events (GRACE) 6-month postdischarge prediction model is a simple, robust tool for predicting mortality in patients with ACS applicable for clinical practice.

United States, Science & research, Care and treatment, Research, Coronary heart disease

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