Ten-Year (2001-2011) Trends in the Incidence Rates and Short-Term Outcomes of Early Versus Late Onset Cardiogenic Shock After Hospitalization for Acute Myocardial Infarction

J Am Heart Assoc. 2017 Jun 7;6(6):e005566. doi: 10.1161/JAHA.117.005566.


Background: Cardiogenic shock (CS) is a serious complication of acute myocardial infarction, and the time of onset of CS has a potential role in influencing its prognosis. Limited contemporary data exist on this complication, however, especially from a population-based perspective. Our study objectives were to describe decade-long trends in the incidence, in-hospital mortality, and factors associated with the development of CS in 3 temporal contexts: (1) before hospital arrival for acute myocardial infarction (prehospital CS); (2) within 24 hours of hospitalization (early CS); and (3) ≥24 hours after hospitalization (late CS).

Methods and results: The study population consisted of 5782 patients with an acute myocardial infarction who were admitted to all 11 hospitals in central Massachusetts on a biennial basis between 2001 and 2011. The overall proportion of patients who developed CS was 5.2%. The proportion of patients with prehospital CS (1.6%) and late CS (1.5%) remained stable over time, whereas the proportion of patients with early CS declined from 2.2% in 2001-2003 to 1.2% in 2009-2011. In-hospital mortality for prehospital CS increased from 38.9% in 2001-2003 to 53.6% in 2009-2011, whereas in-hospital mortality for early and late CS decreased over time (35.9% and 64.7% in 2001-2003 to 15.8% and 39.1% in 2009-2011, respectively).

Conclusions: Development of prehospital and in-hospital CS was associated with poor short-term survival and the in-hospital death rates among those with prehospital CS increased over time. Interventions focused on preventing or treating prehospital and late CS are needed to improve in-hospital survival after acute myocardial infarction.

Keywords: acute myocardial infarction; cardiogenic shock timing; hospital prognosis; population‐based study.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Cause of Death / trends
  • Female
  • Follow-Up Studies
  • Forecasting*
  • Hospital Mortality
  • Hospitalization*
  • Humans
  • Incidence
  • Male
  • Massachusetts / epidemiology
  • Myocardial Infarction / complications*
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / mortality
  • Prognosis
  • Prospective Studies
  • Risk Assessment*
  • Risk Factors
  • Shock, Cardiogenic / epidemiology*
  • Shock, Cardiogenic / etiology
  • Single-Blind Method