期刊
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
卷 67, 期 7, 页码 739-747出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2015.11.048
关键词
cause of death; follow-up studies; heart failure; outcomes assessment; patient readmission; prognosis
资金
- Society of Cardiovascular Patient Care
- American College of Emergency Physicians
- American College of Cardiology Foundation's National Cardiovascular Data Registry (NCDR)
- Abbott Diagnostics
- St. Jude Medical
- Boston Scientific
- Bristol-Myers Squibb
- Daiichi-Sankyo
- Eli Lilly
- Gilead Sciences
- GlaxoSmithKline
- Regeneron Pharmaceuticals
- AstraZeneca
- Premier, Inc.
- Johnson Johnson
- Bayer Healthcare
- Gilead
- Eisai
- Merck
- Arena
- BioagenIdec
- Boehringer Ingelheim
- Boston Clinical Research Institute
- Covance
- Elsevier Practice Update Cardiology
- Forest Pharmaceuticals
- GE Healthcare
- Lexicon
- University of Calgary
- Hoffman-La Roche
- Medtronic Foundation
- Merck Co.
- Pfizer
- Sanofi
- Takeda
- The Medicines Company
- Janssen Pharmaceuticals
- Bayer
- Armethon
BACKGROUND Many patients with acute myocardial infarction (AMI) and cardiogenic shock survive hospitalization; little is known about their subsequent prognosis. OBJECTIVES This study sought to evaluate the associations between cardiogenic shock and post-discharge mortality and all-cause hospitalization among hospital survivors. METHODS We included patients >= 65 years of age with AMI from the ACTION Registry-GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines) who survived hospitalization and linked these patients with Medicare claims data. We used proportional hazards models to test the association between cardiogenic shock and outcomes, adjusting for patient and hospital characteristics. Hazard ratios (HRs) are reported for early (1 to 60 days) and late (61 to 365 days) post-discharge time periods. RESULTS Among 112,668 AMI survivors, 5% had cardiogenic shock during hospitalization. The rate of death was significantly higher among patients with cardiogenic shock at 60 days (9.6% vs. 5.5%) and 1 year (22.4% vs. 16.7%). After accounting for baseline characteristics, the risk of death remained higher for cardiogenic shock patients in the first 60 days after discharge (adjusted HR: 1.62; 95% confidence interval [CI]: 1.46 to 1.80), but was similar to nonshock patients thereafter (adjusted HR: 1.08 for days 61 to 365; 95% CI: 1.00 to 1.18). The rate of all-cause hospitalization or death was significantly higher among shock patients at 60 days (33.9% vs. 24.9%) and 1 year (59.1% vs. 52.3%). After adjustment, the risk of this outcome was also clustered in the first 60 days (adjusted HR: 1.28; 95% CI: 1.21 to 1.35) and was similar thereafter (adjusted HR: 0.95 for days 61 to 365; 95% CI: 0.89 to 1.01). CONCLUSIONS Hospital survivors of AMI who had cardiogenic shock have a higher risk of death and/ or hospitalization during the first year after discharge. The risk is time-dependent and is clustered in the early post-discharge period, after which the prognosis is similar in patients with and without cardiogenic shock. (C) 2016 by the American College of Cardiology Foundation.
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