Trends in Incidence, Management, and Outcomes of Cardiogenic

Background-—Limited information is available on the contemporary and potentially changing trends in the incidence, management, and outcomes of cardiogenic shock complicating ST-elevation myocardial infarction (STEMI). Methods and Results-—We queried the 2003–2010 Nationwide Inpatient Sample databases to identify all patients ≥40 years of age with STEMI and cardiogenic shock. Overall and age-, sex-, and race/ethnicity-specific trends in incidence of cardiogenic shock, early mechanical revascularization, and intra-aortic balloon pump use, and inhospital mortality were analyzed. From 2003 to 2010, among 1 990 486 patients aged ≥40 years with STEMI, 157 892 (7.9%) had cardiogenic shock. The overall incidence rate of cardiogenic shock in patients with STEMI increased from 6.5 % in 2003 to 10.1 % in 2010 (Ptrend<0.001). There was an increase in early mechanical revascularization (30.4 % to 50.7%, Ptrend<0.001) and intra-aortic balloon pump use (44.8 % to 53.7%, Ptrend<0.001) in these patients over the 8-year period. Inhospital mortality decreased significantly, from 44.6 % to 33.8 % (Ptrend<0.001; adjusted OR, 0.71; 95 % CI, 0.68 to 0.75), whereas the average total hospital cost increased from $35 892 to $45 625 (Ptrend<0.001) during the study period. There was no change in the average length of stay (Ptrend=0.394). These temporal trends were similar in patients <75 and ≥75 years of age, men and women, and across each racial/ethnic group. Conclusions-—The incidence of cardiogenic shock complicating STEMI has increased during the past 8 years together with increased use of early mechanical revascularization and intra-aortic balloon pumps. There has been a concomitant decrease in risk-adjusted inhospital mortality, but an increase in total hospital costs during this period. ( J Am Heart Assoc. 2014;3:e000590 doi