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Cardiogenic shock in acute coronary syndrome in the Spanish population

Manuel Ruiz Bailen, Luis Rucabado-Aguilar, Ana Maria Castillo-Rivera, Manuela Exposito-Ruiz, Antonia Morante-Valle, Juan Jose Rodriguez-Garcia, Antonio Pintor-Marmol, Silvia Galindo-Rodriguez, Maria Isabel Ruiz-Garcia, Francisco Javier Gomez Jimenez, Juan Carlos Fernandez-Guerrero, Rafael Vazquez-Garcia, Juan Angel Herrador Fuentes

Med Sci Monit 2008; 14(11): PH46-57

ID: 869426

Published: 2008-10-27

Background: To evaluate the frequency and factors associated with cardiogenic shock (CS) in acute myocardial infarction (AMI) and unstable angina (UA) and percutaneous coronary intervention (PCI).
Material and Method: Spanish registry. The study period was June 1996 to December 2005. Follow-up was length of stay in an intensive care or coronary care unit (ICU/CCU). Multivariate studies evaluated factors associated with CS, mortality in CS, and PCI performance.
Results: The study included 45.688 AMI patients and 17.277 UA patients. Cardiogenic shock occurred in 9.3% of patients with AMI and 1.79% of those with UA, frequencies that decreased over time. Variables associated with cardiogenic shock in AMI patients were female sex, age, type of infarction, diabetes, previous stroke, arrhythmia, previous angiography, complicated angina, and reinfarction. Hypertension and oral beta-blocking, ACE inhibitor, and hypolipidemic agents protected against CS. In UA, these variables were age, previous angina or AMI, right ventricular heart failure, arrhythmia. Beta-blocking agents were associated with a reduction in CS. Deaths from CS and AMI, respectively, were 62.8% and 38.7% in persons with UA. Doing PCIs has increased significantly; it is more prevalent in ex-smokers and those with right ventricular heart failure and mechanical ventilation; lower performance is associated with need for cardiopulmonary resuscitation; patients who die are older or have a history of AMI.
Conclusions: There has been a slight drop in the frequency of CS and its mortality. Factors associated with CS are similar to those associated with acute coronary syndromes. The frequency of PCI was low.

Keywords: Shock, Cardiogenic - surgery, Male, Middle Aged, Humans, Female, Catheter Ablation, Aged, Aged, 80 and over, Time Factors, Spain - epidemiology, Age Distribution, Acute Coronary Syndrome - surgery