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Patients with acute MI, cardiogenic shock at elevated risk for poor outcome within 60 days of discharge
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Among patients with acute MI, those with cardiogenic shock had an increased risk for death or hospitalization at 60 days, but not at 1 year, according to study results.
Little was known about survival of patients with acute MI and cardiogenic shock after hospital discharge, according to the study background.
Rashmee U. Shah, MD, assistant professor of medicine at the University of Utah, Salt Lake City, and colleagues analyzed 112,668 patients aged 65 years or older from the ACTION Registry–Get With The Guidelines who survived hospitalization after acute MI.
The researchers compared outcomes between the 5% of patients with cardiogenic shock and the 95% without it, both in the early (1-60 days) and late (61-365 days) phases after discharge.
Shah and colleagues found that patients with cardiogenic shock had a higher rate of death than those without it at 60 days (9.6% vs. 5.5%) and 1 year (22.4% vs. 16.7%).
After adjustment for baseline characteristics, they determined that risk for death was elevated in those with cardiogenic shock within the first 60 days after discharge (HR = 1.62; 95% CI, 1.46-1.8) but less so between 61 days and 1 year (HR = 1.08; 95% CI, 1-1.18).
The crude rates of all-cause hospitalization or death at 60 days were 33.9% for those with cardiogenic shock and 24.9% for those without, and at 1 year were 59.1% for those with cardiogenic shock and 52.3% for those without, according to the researchers.
After adjustment, they found that cardiogenic shock was associated with increased risk for all-cause hospitalization or death at 60 days (HR = 1.28; 95% CI, 1.21-1.35) but not at 1 year (HR = 0.95; 95% CI, 0.89-1.01).
“There is a need to address the vulnerable immediate post-hospital period,” Shah said in a press release. “Future investigations should identify reasons for this pattern so that interventions could be tailored to improve early survival and identify the sickest patients, who may be better served with palliative care or hospice.”
Adnan Kastrati
In a related editorial, Adnan Kastrati, MD, from Technische Universität, Munich, and colleagues noted that less than one-quarter of rehospitalizations were due to HF, so “these findings should prompt us to focus more on treatment of noncardiac conditions during the in-hospital and early discharge periods in patients with [acute MI] complicated by cardiogenic shock.”
They concluded that the study “underlines the persistent vulnerability of cardiogenic shock patients in the early post-discharge phase and urges us to address means of reducing the risk of adverse outcomes in these patients.” – by Erik Swain
Disclosure: Shah reports owning stock in Gilead Sciences. See the full study for a list of the other researchers’ relevant financial disclosures. One editorial writer reports receiving support from a training initiative sponsored by Merck.
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