Goldberg Robert J, Spencer Frederick A, Gore Joel M, Lessard Darleen, Yarzebski Jorge
Department of Medicine, University of Massachusetts Medical School, Worcester, 01655, USA.
Circulation. 2009 Mar 10;119(9):1211-9. doi: 10.1161/CIRCULATIONAHA.108.814947. Epub 2009 Feb 23.
Limited information is available about potentially changing and contemporary trends in the incidence and hospital death rates of cardiogenic shock complicating acute myocardial infarction. The objectives of our study were to examine 3-decade-long trends (1975 to 2005) in the incidence rates of cardiogenic shock complicating acute myocardial infarction, patient characteristics and treatment practices associated with this clinical complication, and hospital death rates in residents of a large central New England community hospitalized with acute myocardial infarction at all area medical centers.
The study population consisted of 13 663 residents of the Worcester (Mass) metropolitan area hospitalized with acute myocardial infarction at all greater Worcester medical centers during 15 annual periods between 1975 and 2005. Overall, 6.6% of patients developed cardiogenic shock during their index hospitalization. The incidence rates of cardiogenic shock remained stable between 1975 and the late 1990s but declined in an inconsistent manner thereafter. Patients in whom cardiogenic shock developed had a significantly greater risk of dying during hospitalization (65.4%) than those who did not develop cardiogenic shock (10.6%) (P<0.001). Encouraging increases in hospital survival in patients with cardiogenic shock, however, were observed from the mid-1990s to our most recent study years. Several patient demographic and clinical characteristics were associated with an increased risk for developing cardiogenic shock.
Our findings indicate improving trends in the hospital prognosis associated with cardiogenic shock. Given the high death rates associated with this clinical complication, monitoring future trends in the incidence and death rates and the factors associated with an increased risk for developing cardiogenic shock remains warranted.
关于急性心肌梗死并发心源性休克的发病率和医院死亡率潜在的变化及当代趋势，可获取的信息有限。我们研究的目的是考察1975年至2005年这三十年期间，急性心肌梗死并发心源性休克的发病率趋势、与这种临床并发症相关的患者特征和治疗方法，以及在新英格兰中部一个大型社区，所有地区医疗中心收治的急性心肌梗死住院患者的医院死亡率。
研究人群包括1975年至2005年期间，在伍斯特（马萨诸塞州）大都市地区所有大伍斯特医疗中心因急性心肌梗死住院的13663名居民。总体而言，6.6%的患者在其首次住院期间发生心源性休克。1975年至20世纪90年代末，心源性休克的发病率保持稳定，但此后呈不一致的下降趋势。发生心源性休克的患者住院期间死亡风险（65.4%）显著高于未发生心源性休克的患者（10.6%）（P<0.001）。然而，从20世纪90年代中期到我们最近的研究年份，观察到心源性休克患者的医院生存率有令人鼓舞的提高。一些患者的人口统计学和临床特征与发生心源性休克的风险增加有关。
我们的研究结果表明，与心源性休克相关的医院预后呈改善趋势。鉴于这种临床并发症的高死亡率，监测发病率和死亡率的未来趋势以及与发生心源性休克风险增加相关的因素仍然是必要的。
