Trends in incidence,management,and outcomes of cardiogenic shock complicating ST-elevation myocardial infarction in the United States.

Limited information is available on the contemporary and potentially changing trends in the incidence,management,and outcomes of cardiogenic shock complicating st-elevation myocardial infarction (stemi). we queried the 2003-2010 nationwide inpatient sample databases to identify all patients ≥ 40 years of age with stemi and cardiogenic shock. overall and age-,sex-,and race/ethnicity-specific trends in incidence of cardiogenic shock,early mechanical revascularization,and intra-aortic balloon pump use,and inhospital mortality were analyzed. from 2003 to 2010,among 1 990 486 patients aged ≥ 40 years with stemi,157 892 (7.9%) had cardiogenic shock. the overall incidence rate of cardiogenic shock in patients with stemi increased from 6.5% in 2003 to 10.1% in 2010 (p(trend)<0.001). there was an increase in early mechanical revascularization (30.4% to 50.7%,p(trend)<0.001) and intra-aortic balloon pump use (44.8% to 53.7%,p(trend)<0.001) in these patients over the 8-year period. inhospital mortality decreased significantly,from 44.6% to 33.8% (p(trend)<0.001; adjusted or,0.71; 95% ci,0.68 to 0.75),whereas the average total hospital cost increased from $35 892 to $45 625 (p(trend)<0.001) during the study period. there was no change in the average length of stay (p(trend)=0.394). these temporal trends were similar in patients <75 and ≥ 75 years of age,men and women,and across each racial/ethnic group. the incidence of cardiogenic shock complicating stemi has increased during the past 8 years together with increased use of early mechanical revascularization and intra-aortic balloon pumps. there has been a concomitant decrease in risk-adjusted inhospital mortality,but an increase in total hospital costs during this period.