Regional Incidence and Disease Burden of Acute Myocardial Infarction With Cardiogenic Shock in an Aging Rural Catchment Area ― A 6-Year Single-Center Study ―

Background: Acute myocardial infarction complicated by cardiogenic shock (AMICS) remains associated with high mortality rates despite advances in reperfusion therapy and mechanical circulatory support. However, population-based data from super-aging rural regions in Japan remain limited. Methods and Results: We conducted a retrospective single-center study in a rural catchment area of approximately 200,000 residents. Consecutive patients with AMICS who underwent percutaneous coronary intervention between January 2019 and December 2024 were included. Among 784 patients with AMI, 88 (11.2%) had cardiogenic shock. The annual incidence of AMI ranged from 50 to 70 per 100,000 persons, whereas AMICS occurred in approximately 5–7 per 100,000 persons. The mean age was 73.8±12.7 years, and the in-hospital mortality rate was 40%. Direct emergency medical service transport was used for 63 patients (71.5%), while 19 (21.5%) required secondary interhospital transfer. Median transfer time was 30 (interquartile range [IQR], 23–47) min, and the median transport distance was 14.0 (IQR, 3.0–26.6) km. Older age was associated with in-hospital death in univariate analysis, but no independent predictor remained significant after multivariable adjustment. Conclusions: Although relatively uncommon, AMICS imposed a substantial clinical and healthcare system burden in this super-aging rural region. These findings highlighted the importance of optimizing regional cardiovascular emergency systems in geographically wide rural areas.