Twenty-Year Trends in the Incidence and Outcome of Cardiogenic Shock in AMIS Plus Registry
Authors: Hunziker Lukas , Radovanovic Dragana , Jeger Raban , Pedrazzini Giovanni , Cuculi Florim , Urban Philip , Erne Paul , Rickli Hans , Pilgrim Thomas ,   the AMIS Plus Registry Investigators, Hess F. , Simon R. , Hangartner P.J. , Hufschmid U. , Hornig B. , Altwegg L. , Trummler S. , Windecker S. , Rueff T. , Loretan P. , Roethlisberger C. , Evéquoz D. , Mang G. , Ryser D. , Müller P. , Jecker R. , Kistler W. , Hongler T. , Stäuble S. , Freiwald G. , Schmid H.P. , Stauffer J.C. , Cook S. , Bietenhard K. , Roffi M. , Wojtyna W. , Schönenberger R. , Simonin C. , Waldburger R. , Schmidli M. , Federspiel B. , Weiss E.M. , Marty H. , Weber K. , Zender H. , Poepping I. , Hugi A. , Koltai E. , Iglesias J.F. , Erne P. , Heimes T. , Jordan B. , Pagnamenta A. , Feraud P. , Beretta E. , Stettler C. , Repond F. , Widmer F. , Heimgartner C. , Polikar R. , Bassetti S. , Iselin H.U. , Giger M. , Egger P. , Kaeslin T. , Fischer A. , Herren T. , Eichhorn P. , Neumeier C. , Flury G. , Girod G. , Vogel R. , Niggli B. , Yoon S. , Nossen J. , Stoller U. , Veragut U.P. , Bächli E. , Weber A. , Schmidt D. , Hellermann J. , Eriksson U. , Fischer T. , Peter M. , Gasser S. , Fatio R. , Vogt M. , Ramsay D. , Wyss C. , Bertel O. , Maggiorini M. , Eberli F. , Christen S. 
Published: April 2019

Background:
Long-term trends of the incidence and outcome of cardiogenic shock (CS) patients are scarce. We analyze for the first time trends in the incidence and outcome of CS during a 20-year period in Switzerland.

Methods and Results:

The AMIS (Acute Myocardial Infarction in Switzerland) Plus Registry enrolls patients with acute myocardial infarction from 83 hospitals in Switzerland. We analyzed trends in the incidence, treatment, and in-hospital mortality of patients with CS enrolled between 1997 and 2017. The impact of revascularization strategy on outcome was assessed for the time period 2005 to 2017. Among 52 808 patients enrolled, 963 patients were excluded because of missing data and 51 842 (98%) patients remained for the purpose of the present analysis. Overall, 4090 patients (7.9%) with a mean age of 69.6±12.5 years experienced acute myocardial infarction complicated by CS. Overall, rates of CS declined from 8.7% to 7.3% between 1997 and 2017 (
P
for trend, <0.001; 1997–2006 versus 2007–2017). We observed a decrease in CS developing during hospitalization from 7.8% to 3.5% in the period 1997 to 2006 compared with 2007 to 2017 (
P
for trend, <0.001), which was partially offset by an increase in CS on admission between 2006 and 2017 (2.5% [1997–2006] to 4.6% [2007–2017];
P
for trend, <0.001). In-hospital mortality declined from 62.2% in 1997 to 36.3% in 2017 (
P
<0.001 for temporal trend). Percutaneous coronary intervention was the strongest independent predictor for survival (odds ratio, 0.36; CI, 0.28–045;
P
<0.001). Among patients with acute myocardial infarction and multivessel disease, multivessel percutaneous coronary intervention was associated with an increased risk of in-hospital mortality (odds ratio, 1.88; 95% CI, 1.59–2.21) and was an independent predictor for the development of CS during hospitalization (odds ratio, 1.93; 95% CI, 1.62–2.30).

Conclusions:
Rates of CS declined between 1997 and 2017 driven by a reduction of CS developing during hospitalization. In-hospital mortality from CS declined from 62.8% (1997) to <40% (2017). Multivessel percutaneous coronary intervention was associated with an increased risk of mortality and the development of CS during hospitalization.