Long-Term Outcomes of Cardiogenic Shock Complicating Myocardial Infarction.

Background: Cardiogenic shock secondary to acute myocardial infarction (AMI-CS) is associated with substantial short-term mortality; however, there are limited data on long-term outcomes and trends.
Objectives: This study sought to examine long-term outcomes of AMI-CS patients.
Methods: This was a population-based, retrospective cohort study in Ontario, Canada of critically ill adult patients with AMI-CS who were admitted to hospitals between April 1, 2009 and March 31, 2019. Outcome data were captured using linked health administrative databases.
Results: A total of 9,789 consecutive patients with AMI-CS from 135 centers were included. The mean age was 70.5 ± 12.3 years, and 67.7% were male. The incidence of AMI-CS was 8.2 per 100,000 person-years, and it increased over the study period. Critical care interventions were common, with 5,422 (55.4%) undergoing invasive mechanical ventilation, 1,425 (14.6%) undergoing renal replacement therapy, and 1,484 (15.2%) receiving mechanical circulatory support. A total of 2,961 patients (30.2%) died in the hospital, and 4,004 (40.9%) died by 1 year. Mortality at 5 years was 58.9%. Small improvements in short- and long-term mortality were seen over the study period. Among survivors to discharge, 2,870 (42.0%) required increased support in care from their preadmission baseline, 3,244 (47.5%) were readmitted to the hospital within 1 year, and 1,047 (15.3%) died within 1 year. The mean number of days at home in the year following discharge was 307.9 ± 109.6.
Conclusions: Short- and long-term mortality among patients with AMI-CS is high, with minimal improvement over time. AMI-CS survivors experience significant morbidity, with high risks of readmission and death. Future studies should evaluate interventions to minimize postdischarge morbidity and mortality among AMI-CS survivors.
Competing Interests: Funding Support and Author Disclosures This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and Ministry of Long-term Care (MLTC). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOH/MLTC is intended or should be inferred. Parts of this material are based on data and/or information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, and opinions and statements expressed in the material are those of the authors, and not necessarily those of CIHI. Dr Brodie has received research support from LivaNova outside of the submitted work; and has served on medical advisory boards for LivaNova, Abiomed, Xenios, Medtronic, Inspira, and Cellenkos. Dr Fan has received personal fees from ALung Technologies, Aerogen, Baxter, GE Healthcare, Inspira, and Vasomune outside of the submitted work. Dr Basir has served as a consultant for Abbott Vascular, Abiomed, Boston Scientific, Cardiovascular Systems, Chiesi, Saranas. and Zoll. Dr Combes has received personal fees from Getinge, Baxter, and Xenios outside of the submitted work. Dr Tanuseputro has received support from a Physician Services Incorporated Graham Farquharson Knowledge Translation Fellowship. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)