Key result
Cardiogenic shock on admission in ACS patients at non-invasive hospitals was associated with significantly higher in-hospital mortality compared to patients without shock (63.6% vs 6.2%, P<0.001).
Why the study?
Does cardiogenic shock on admission worsen in-hospital mortality and alter management in ACS patients admitted to hospitals without on-site invasive facilities?
Cohort (n=1,313)
Yes
Does cardiogenic shock on admission worsen in-hospital mortality and alter management in ACS patients admitted to hospitals without on-site invasive facilities?
Cardiogenic shock on admission in ACS patients at non-invasive centers is associated with lower rates of invasive transfer in STEMI, less use of guideline-directed medical therapy, and exceedingly high in-hospital mortality.
ACS cardiogenic shock at non-invasive hospitals signals extreme mortality risk; leaves open whether systematic transfer or optimized GDMT improves outcomes.
BACKGROUND: The purpose was to identify predictors of cardiogenic shock (CS) on admission and to asses associations between CS and real-life management patterns and outcomes in unselected cohort of acute coronary syndrome (ACS) patients admitted to hospitals without onsite invasive facilities. METHODS: Data concerning in-hospital management and mortality of 56 (4.3%) patients with and 1257 (95.7%) without CS on hospital admission was assessed. RESULTS: Prior myocardial infarction, prior heart failure symptoms, age, and diabetes mellitus were independently associated with increased risk of CS on admission. A total of 23.8% patients were transferred for invasive treatment during index hospital stay and the frequency of transfer was similar among patients with and without CS on admission (21.4% versus 23.9%; P = 0.75), but in the STEMI subgroup, patients with shock were transported less frequently (21.4% versus 43.8%; P = 0.0027). CS patients were less likely to receive guideline-recommended therapies including antiplatelet drugs, statins, and beta-blockers. In-hospital mortality was lower in non-shock patients (6.2% versus 63.6%; P < 0.001) and CS on admission was an independent predictor of in-hospital death. CONCLUSIONS: CS on admission is an important determinant of treatment strategy selection and is associated with unfavorable prognosis of ACS patients admitted to hospitals without on-site invasive facilities.
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Dziewierz et al. (2010) conducted a cohort in Acute coronary syndromes (ACS) (n=1,313). Cardiogenic shock on admission vs. No cardiogenic shock on admission was evaluated on In-hospital mortality (p=<0.001). Cardiogenic shock on admission in ACS patients at non-invasive hospitals was associated with significantly higher in-hospital mortality compared to patients without shock (63.6% vs 6.2%, P<0.001).
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