Key result
Revascularization reduced mortality to 28.7% compared to 57.4% with conservative therapy in patients with acute coronary syndrome complicated by cardiogenic shock.
Why the study?
Mortality in ACS complicated by cardiogenic shock remains high, motivating an evaluation of medical care quality and its compliance with clinical guidelines.
Does revascularization (PCI or thrombolysis) reduce mortality compared to conservative treatment in patients with acute coronary syndrome complicated by cardiogenic shock?
Observational (n=824)
Yes
Does revascularization (PCI or thrombolysis) reduce mortality compared to conservative treatment in patients with acute coronary syndrome complicated by cardiogenic shock?
Absolute Event Rate: 28.7% vs 57.4%
p-value: p=<0.001
Real-world registry data from Russia shows that a significant proportion of ACS patients with cardiogenic shock do not receive guideline-directed revascularization, which is associated with markedly higher mortality.
Highlights underuse of revascularization in ACS with cardiogenic shock; leaves open causal confirmation in randomized trials.
Mortality in acute coronary syndrome (ACS) and its complications remains high, despite significant advances in the treatment of coronary heart disease and its complications. One of the most life - threatening complications of ACS is cardiogenic shock (CS). CS is an extreme degree of acute heart failure and develops on average in 5-8% of patients hospitalized with ACS. In the present work, we analyzed data from Russian Federal ACS Registry - frequency of CS occurrence, treatment methods, and outcomes of ACS complicated by CS. AIM: Assess the quality of medical care in patients with ACS, which complicated by CS, and its compliance with current clinical guidelines. MATERIALS AND METHODS: Data from patients with ACS were exported from the Russian Federal ACS Registry. The study analyzed the data of 29.736 patients with ACS entered into the registry system in the period from 01.01.2018 to 31.12.2018. Of the 29.736 patients with ACS, 824 patients were diagnosed with CS. To assess the quality of care provided to patients with ACS and CS, the main clinical gguidelines were used. RESULTS: The group of 824 patients with ACS and CS was analyzed. Among them patients with ACS with ST segment elevation prevailed - 77.8% (n=641). According to Russian Federal ACS Registry 44.3% (n=365) of patients with ACS and CS received conservative treatment, of which 58.6% (n=108) were with ACS with ST segment elevation. Percutaneous coronary intervention was performed in 39% (n=321) of patients, of whom 89.4% (n=271) of patients with ACS with ST segment elevation. According to the data of this study, thrombolytic therapy was performed in 26.5% (n=218) of patients. CONCLUSION: The data obtained demonstrated that patients with ACS and CS did not receive optimal medical care and their treatment does not fully comply with modern clinical guidelines.
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Sagaydak et al. (2019) conducted an observational in Acute Coronary Syndrome complicated by Cardiogenic Shock (n=824). Revascularization (PCI or thrombolytic therapy) vs. Conservative therapy was evaluated on Mortality (p=<0.001). Revascularization reduced mortality to 28.7% compared to 57.4% with conservative therapy in patients with acute coronary syndrome complicated by cardiogenic shock.
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