Choque cardiogénico no enfarte agudo do miocárdio: o que mudou nos últimos 10 anos?

Background: Despite improvements in treatment, mortality associated with cardiogenic shock (CS) following acute myocardial infarction remains high. Aim: To compare two groups of patients admitted with CS over a 10-year time span. Methods: We performed a retrospective analysis of two patient populations presenting with CS admitted in the periods May 1998-May 2001 (group A) and May 2008-May 2011 (group B). Clinical characteristics, diagnostic methods, treatment and outcomes were compared, and independent predictors of death at six months were analyzed. RESULTS: The incidence of CS was 3.7% in group A (n=25) and 4.8% in group B (n=42). There were no significant differences in clinical characteristics except for age (60.2±12.3 vs. 66.5±11.3 years; p=0.043) and the proportion of patients admitted within six hours of symptom onset (29.2% vs. 54.8%, p=0.045). There was a reduction in use of pulmonary artery catheterization (52.0% vs. 19.0%, p=0.005) but an increase in dialysis (4.0% vs. 28.6%, p=0.014). There was no difference in the proportion of patients reperfused within 12 hours or revascularized, but use of percutaneous coronary intervention (PCI) increased (75.0% vs. 92.9%, p=0.042). There were no differences in outcomes, including mortality at 30 days (32.0 vs. 35.7%; p=0.757) and six months (36.0 vs. 42.9%; p=0.683). Diabetes was the sole baseline characteristic identified as an independent predictor of death at six months (hazard ratio [HR] 3.02; 95% confidence interval [CI] 1.38-6.60; p=0.006) and mortality was lower among revascularized patients (HR 0.11; 95% CI 0.03-0.42; p=0.001). Conclusions: Over a 10-year time span, despite earlier hospital admission and increased use of support therapies and PCI, short- and medium-term mortality remained unchanged.