Recent magnitude of and temporal trends (1994-1997) in the incidence and hospital death rates of cardiogenic shock complicating acute myocardial infarction: The second National Registry of Myocardial Infarction
Recent magnitude of and temporal trends (1994-1997) in the incidence and hospital death rates of cardiogenic shock complicating acute myocardial infarction: The second National Registry of Myocardial Infarction
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DOI：
10.1067/mhj.2001.111405
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发表时间：
2001-01-01
影响因子：
4.8
通讯作者：
Gurwitz, JH
中科院分区：
文献类型：
--
作者：
Goldberg, RJ;Gore, JM;Gurwitz, JH
背景 目前可用于描述与急性心肌梗死并发心源性休克相关的发病率和病死率的严重程度和时间趋势的数据有限。本研究的目的是从全国范围内大型、多医院的角度考察急性心肌梗死并发心源性休克的发病率和医院死亡率的最新趋势（1994-1997）。方法对 1994 年至 1997 年间美国 1662 家医院的 426,253 名因急性心肌梗死住院的患者进行了观察性研究。结果 心源性休克的平均发病率6.2%。有证据表明，1994 年 (6.6%) 至 1997 年 (6.0%) 期间这些比率略有下降。控制可能影响心源性休克发生风险的因素的多变量回归分析结果表明，近年来住院的患者发生休克的风险显着降低。与未发生休克的患者相比，发生休克的患者在住院期间死亡的风险显着增加（74% vs 10%）。随着时间的推移，心源性休克后的死亡风险观察到显着（尽管很小）的绝对差异（1997 年死亡率为 76%，1994 年死亡率为 72%）。然而，在控制了潜在的混杂预后因素后，这些改善趋势被放大：1997 年休克患者的死亡风险比 1994 年住院患者低约五分之一（比值比 0.79，95% 置信区间 0.71-0.87）。 结论 我们的研究结果表明，心源性休克的发生率略有下降，休克患者的医院生存率呈改善趋势。尽管存在这些趋势，但鉴于其高致死率，预防这种临床综合征仍然相当重要。
Background Limited recent data are available to describe the magnitude of, and temporal trends in, the incidence and case-fatality rates associated with cardiogenic shock complicating acute myocardial infarction. The purpose of this study was to examine recent (1994-1997) trends in the incidence of, and hospital death rates From, cardiogenic shock complicating acute myocardial infarction from a large, multihospital national perspective.Methods An observational study was performed of 426,253 patients hospitalized with acute myocardial infarction in 1662 hospitals throughout the United States between 1994 and 1997. Results The incidence rates of cardiogenic shock averaged 6.2%. There was evidence for a slight decline in these rates between 1994 (6.6%) and 1997 (6.0%).Results of a multivariable regression analysis controlling for factors that might affect the risk of development of cardiogenic shock indicated that patients hospitalized in more recent years were at significantly lower risk for shock. Patients with shock had a markedly increased risk for dying during hospitalization compared with patients not having shock (74% vs 10%). Significant, albeit small, absolute differences were observed in the risk of dying after cardiogenic shock over time (76% dying in 1997 72% dying in 1994). These improving trends were magnified, however, after potentially confounding prognostic factors were controlled: patients having shock in 1997 were at approximately one fifth lower risk of dying (odds ratio 0.79, 95% confidence interval 0.71-0.87) than those hospitalized in 1994.Conclusions Our findings indicate a slight decline in the incidence rates of cardiogenic shock and improving trends in the hospital survival of patients with shock. Despite these trends, it remains of considerable importance to prevent this clinical syndrome, given its high lethality.