Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Division of Cardiology, Department of Medicine, Mount Auburn Hospital, Cambridge, MA; Harvard Medical School, Boston, MA, USA.
Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Int J Cardiol. 2022 Nov 15;367:45-48. doi: 10.1016/j.ijcard.2022.08.043. Epub 2022 Aug 21.
Observational and trial data have revealed significant improvement in cardiogenic shock (CS) mortality due to acute myocardial infarction (AMI) after introducing early coronary revascularization. Less is known about CS mortality due to heart failure (HF), which is increasingly recognized as a distinct entity from AMI-CS.
In this nationwide observational study, the CDC WONDER database was used to identify national trends in age-adjusted mortality rates (AAMR) due to CS (HF vs. AMI related) per 100,000 people aged 35-84. AAMR from AMI-CS decreased significantly from 1999 to 2009 (AAPC: -6.9% [95%CI -7.7, -6.1]) then stabilized from 2009 to 2020. By contrast, HF-CS associated AAMR rose steadily from 2009 to 2020 (AAPC: 13.3% [95%CI 11.4,15.2]). The mortality rate was almost twice as high in males compared to females in both AMI-CS and HF-CS throughout the study period. HF-CS mortality in the non-Hispanic Black population is increasing more quickly than that of the non-Hispanic White population (AAMR in 2020: 4.40 vs. 1.97 in 100,000). The AMI-CS mortality rate has been consistently higher in rural than urban areas (30% higher in 1999 and 28% higher in 2020).
These trends highlight the fact that HF-CS and AMI-CS represent distinct clinical entities. While mortality associated with AMI-CS has primarily declined over the last two decades, the mortality related to HF-CS has increased significantly, particularly over the last decade, and is increasing rapidly among individuals younger than 65. Accordingly, a dramatic change in the demographics of CS patients in modern intensive care units is expected.
观察性研究和临床试验数据显示，急性心肌梗死（AMI）并发心源性休克（CS）患者的早期冠状动脉血运重建可显著降低死亡率。心力衰竭（HF）导致 CS 的死亡率数据相对较少，HF 已被认为是与 AMI-CS 不同的实体。
本全国性观察性研究利用疾病预防控制中心 WONDER 数据库，确定每 10 万人中年龄调整后死亡率（AAMR）（HF 与 AMI 相关）的全国趋势。1999 年至 2009 年 AMI-CS 的 AAMR 显著下降（AAPC：-6.9%[95%CI -7.7，-6.1%]），之后 2009 年至 2020 年趋于稳定。相比之下，HF-CS 相关 AAMR 从 2009 年至 2020 年稳步上升（AAPC：13.3%[95%CI 11.4，15.2%]）。在整个研究期间，AMI-CS 和 HF-CS 中男性的死亡率几乎是女性的两倍。非西班牙裔黑人 HF-CS 死亡率的增长速度快于非西班牙裔白人（2020 年 AAMR：每 10 万人中 4.40 比 1.97）。AMI-CS 死亡率在农村地区一直高于城市地区（1999 年高出 30%，2020 年高出 28%）。
这些趋势表明 HF-CS 和 AMI-CS 代表不同的临床实体。AMI-CS 死亡率在过去二十年中主要下降，而 HF-CS 死亡率显著上升，尤其是在过去十年中，65 岁以下人群的死亡率上升迅速。因此，现代重症监护病房 CS 患者的人口统计学特征预计将发生巨大变化。
Zotero 插件