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Background Cardiogenic shock remains the leading cause of in hospital death in acute myocardial infarction (AMI) and is associated with a mortality rate of approximately 50%. Here we investigated the 17-year trends in incidence and prognosis of AMI-induced cardiogenic shock in Västra Götaland in western Sweden, an area with approximately 1.6 million inhabitants. The study period includes the transition from thrombolysis to primary percutaneous coronary intervention (PCI) as the region-wide therapy of choice for patients with ST-elevation myocardial infarction (STEMI). Methods Data on patients hospitalized in cardiac care units in Västra Götaland, Sweden between 1995 and 2013 were obtained from the Swedish Websystem for Enhancement of Evidence-based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART). We determined the incidence of cardiogenic shock among patients diagnosed with AMI and the risk of death associated with developing cardiogenic shock. We fitted logistic regression models to study which factors predicted post-AMI cardiogenic shock. Analyses were performed on complete case data as well as after multiple imputation of missing data. Results Incidence of cardiogenic shock as a complication of AMI declined in western Sweden in the past decade, from 14% in 1995 to 4% in 2012. The risk of dying once cardiogenic shock had developed increased during the study period (p < 0.01). Patients presenting with STEMI were more likely to develop cardiogenic shock than patients presenting with non STEMI (p < 0.001). Conclusions The incidence of cardiogenic shock has declined but cardiogenic shock carries a worse prognosis today than in 1995. [ABSTRACT FROM AUTHOR]

Abstract: Background: Recent population-based estimates for long-term cardiovascular disease (CVD) mortality after hospitalization for a first acute myocardial infarction (AMI) are not well established. Methods: Data from the Swedish hospital discharge and death registries were used to record all first-ever hospital admissions in patients (n=348,772) 35–84years with AMI from 1987 to 2006 and subsequent all-cause and CVD case fatality during up to 5years. Results: During the 20-year period, 28-day case fatality was reduced by almost two thirds in patients aged <75years. For cases with a first AMI 1999–2002 long-term case fatality for men surviving the first 28days and <55years was 10.3/1000 person years, with rates of 23.6, 58.0 and 137.0 for men aged 55–64, 65–74 and 75–84years. Corresponding figures for women were 10.5, 24.3, 51.8, 124.1 deaths/1000years. In 1999–2002 estimated long-term risk of fatal CVD (based on survival until 2007) for men below 55years was 6.1/1000years, and 13.8, 34.6, 92.9 for men aged 55–64, 65–74, and 75–84years, respectively. Corresponding figures for women were 4.8, 11.9, 30.1, 86.2/1000years. The total reduction in CVD case fatality was two thirds among patients aged <55 and approximately one third among those aged 75–84. Conclusions: Long-term case fatality after hospitalization for AMI decreased markedly from 1987 to 2006, particularly with respect to CVD mortality and in younger patients. However, because of a steep increase in case fatality with age and a large proportion of older patients, long-term prognosis overall still remains poor. [Copyright &y& Elsevier]