Comparison of the prognosis among in-hospital survivors of cardiogenic shock based on etiology: AMI and Non-AMI

• Published in: Annals of intensive care Vol. 14; no. 1; p. 74
• Main Authors: Chien, Shih-Chieh, Wang, Cheng-An, Liu, Hung-Yi, Lin, Chao-Feng, Huang, Chun-Yao, Chien, Li-Nien
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 12.05.2024; Springer Nature B.V; SpringerOpen
• Subjects: Anesthesiology; Cardiogenic shock; Clinical outcomes; Critical Care Medicine; Emergency Medicine; Etiology; Heart attacks; Intensive; Long-term outcomes after critical illness; Long-term prognosis; Medical prognosis; Medicine; Medicine & Public Health; Mortality; Myocardial infarction; Rehospitalization; Shock (Circulatory); Survivor; Long-term prognosis; Myocardial infarction; Rehospitalization; Cardiogenic shock; Mortality
• ISSN: 2110-5820; 2110-5820
• DOI: 10.1186/s13613-024-01305-2

Background Current data on post-discharge mortality and rehospitalization is still insufficient among in-hospital survivors of cardiogenic shock (CS), including acute myocardial infarction (AMI) and non-AMI survivors. Methods Patients with CS who survived after hospital discharge were selected from the Taiwan National Health Insurance Research Database. Each patient was followed up at 3-year intervals. Mortality and rehospitalization were analyzed using Kaplan-Meier curves and Cox regression models. Results There were 16,582 eligible patients. Of these, 42.4% and 57.6% were AMI-CS and non-AMI-CS survivors, respectively. The overall mortality and rehospitalization rates were considerably high, with reports of 7.0% and 22.1% at 30 days, 24.5% and 58.2% at 1 year, and 38.9% and 73.0% at 3 years, respectively, among in-hospital CS survivors. Cardiovascular (CV) problems caused approximately 40% mortality and 60% rehospitalization. Overall, the non-AMI-CS group had a higher mortality burden than the AMI-CS group owing to older age and a higher prevalence of comorbidities. In multivariable models, the non-AMI-CS group exhibited a lower risk of all-cause mortality (adjusted hazard ratio [aHR] 0.69, 95% confidence interval [CI] 0.60 to 0.78) and CV mortality (aHR 0.65, 95% CI 0.54 to 0.78) compared to the AMI-CS group. However, these risks diminished and even reversed after one year (aHR 1.13, 95% CI 1.03 to 1.25 for all-cause mortality; aHR 1.27, 95% CI 1.09 to 1.49 for CV mortality).This reversal was not observed in all-cause and CV rehospitalization. For rehospitalization, AMI-CS was associated with the risk of CV rehospitalization in the entire observation period (aHR:0.80, 95% CI:0.76–0.84). Conclusions In-hospital AMI-CS survivors had an increased risk of CV rehospitalization and 30-day mortality, whereas those with non-AMI-CS had a greater mortality risk after 1-year follow-up.