Short- and Long-Term Mortality Trends in STEMI-Cardiogenic Shock over Three Decades (1989-2018): The Ruti-STEMI-Shock Registry
Por:
Garcia-Garcia, C, Oliveras, T, El Ouaddi, N, Rueda, F, Serra, J, Labata, C, Ferrer, M, Cediel, G, Montero, S, Martinez, MJ, Resta, H, de Diego, O, Vila, J, Degano, IR, Elosua, R, Lupon, J and Bayes-Genis, A
Publicada:
1 ago 2020
Ahead of Print:
27 jul 2020
Resumen:
Aims: Cardiogenic shock (CS) is an ominous complication of ST-elevation myocardial infarction (STEMI), despite the recent widespread use of reperfusion and invasive management. The Ruti-STEMI-Shock registry analysed the prevalence of and 30-day and 1-year mortality rates in ST-elevation myocardial infarction (STEMI) complicated by CS (STEMI-CS) over the last three decades. Methods and Results: From February 1989 to December 2018, 493 STEMI-CS patients were consecutively admitted in a well-defined geographical area of similar to 850,000 inhabitants. Patients were classified into six five-year periods based on their year of admission. STEMI-CS mortality trends were analysed at 30 days and 1 year across the six strata. Cox regression analyses were performed for comparisons. Mean age was 67.5 +/- 11.7 years; 69.4% were men. STEMI-CS prevalence did not decline from period 1 to 6 (7.1 vs. 6.2%,p= 0.218). Reperfusion therapy increased from 22.5% in 1989-1993 to 85.4% in 2014-2018. Thirty-day all-cause mortality declined from period 1 to 6 (65% vs. 50.5%,p< 0.001), with a 9% reduction after multivariable adjustment (HR: 0.91; 95% CI: 0.84-0.99;p= 0.024). One-year all-cause mortality declined from period 1 to 6 (67.5% vs. 57.3%,p= 0.001), with an 8% reduction after multivariable adjustment (HR: 0.92; 95% CI: 0.85-0.99;p= 0.030). Short- and long-term mortality trends in patients aged >= 75 years remained similar to 75%. Conclusions: Short- and long-term STEMI-CS-related mortality declined over the last 30 years, to similar to 50% of all patients. We have failed to achieve any mortality benefit in STEMI-CS patients over 75 years of age.
Filiaciones:
:
Hosp Badalona Germans Trias & Pujol, Inst Heart, Badalona 08916, Spain
CIBER Enfermedades Cardiovasc CIBERCV, Madrid 08080, Spain
:
Hosp Badalona Germans Trias & Pujol, Inst Heart, Badalona 08916, Spain
Autonomous Univ Barcelona, Dept Med, Barcelona 08916, Spain
:
Hosp Badalona Germans Trias & Pujol, Inst Heart, Badalona 08916, Spain
:
Hosp Badalona Germans Trias & Pujol, Inst Heart, Badalona 08916, Spain
:
Hosp Badalona Germans Trias & Pujol, Inst Heart, Badalona 08916, Spain
Labata, C:
Hosp Badalona Germans Trias & Pujol, Inst Heart, Badalona 08916, Spain
:
Hosp Badalona Germans Trias & Pujol, Inst Heart, Badalona 08916, Spain
:
Hosp Badalona Germans Trias & Pujol, Inst Heart, Badalona 08916, Spain
:
Hosp Badalona Germans Trias & Pujol, Inst Heart, Badalona 08916, Spain
:
Hosp Badalona Germans Trias & Pujol, Inst Heart, Badalona 08916, Spain
Resta, H:
Hosp Badalona Germans Trias & Pujol, Inst Heart, Badalona 08916, Spain
:
Hosp Badalona Germans Trias & Pujol, Inst Heart, Badalona 08916, Spain
Vila, J:
IMIM Inst Hosp Mar Invest Med, REGICOR Study Grp, Barcelona 08003, Spain
Degano, IR:
CIBER Enfermedades Cardiovasc CIBERCV, Madrid 08080, Spain
IMIM Inst Hosp Mar Invest Med, REGICOR Study Grp, Barcelona 08003, Spain
Elosua, R:
CIBER Enfermedades Cardiovasc CIBERCV, Madrid 08080, Spain
Univ Vic Cent Univ Catalonia UVic UCC, Fac Med, Vic 08500, Spain
IMIM, Cardiovasc Epidemiol & Genet Grp, Barcelona 08003, Spain
:
Hosp Badalona Germans Trias & Pujol, Inst Heart, Badalona 08916, Spain
CIBER Enfermedades Cardiovasc CIBERCV, Madrid 08080, Spain
Autonomous Univ Barcelona, Dept Med, Barcelona 08916, Spain
:
Hosp Badalona Germans Trias & Pujol, Inst Heart, Badalona 08916, Spain
CIBER Enfermedades Cardiovasc CIBERCV, Madrid 08080, Spain
Autonomous Univ Barcelona, Dept Med, Barcelona 08916, Spain
Green Published, gold
|