Does Cardiogenic Shock Affect Mortality, Heart Failure Risks Among First-time MI Survivors?

A study that investigated rates of heart failure hospitalization and mortality among patients following their first myocardial infarction (MI, or heart attack) found risks for both measures to be elevated in the ensuing year for patients who also had cardiogenic shock (CS) compared with patients who did not, reports European Heart Journal: Acute Cardiovascular Care.

Beyond this timeframe, noticeable differences were not seen in 1-year survivors. Data were provided by the Danish National Patient Registry on the primary diagnosis. All hospital admissions since 1977 and all hospital outpatient specialist clinic and emergency department contacts since 1995 are covered by the registry.

“Data on the association between CS and the long-term risks of heart failure or death are sparse,” the study authors noted, “as previous studies have been of limited size and/or follow-up.”

Their primary outcomes were heart failure hospitalization and all-cause death.

This nationwide, cohort Danish study, which also looked at 5- and 1-to-5-year rates, included 2 cohorts, with all patients having their first MI between January 1, 2005, and December 31, 2017, and alive at hospital discharge: 2865 patients who had CS and 83,000 who did not. Their median (interquartile range [IQR]) ages were similar, 67 (IQR, 58-75) and 68 (58-78) years, respectively, but there were more men in the CS group (69.8% vs 64.5%) and the group had an overall longer hospitalization, at 10 (IQR, 5-18) compared with 4 (IQR, 3-7) days.

The CS group also had overall higher rates of the following comorbidities compared with the non-CS group:

• Peripheral vascular disease: 9.1% vs 6.2% (P < .0001)
• Cerebrovascular disease: 9.9% vs 9.2% (P = .22)
• Chronic obstructive pulmonary disease: 7.0% vs 5.0% (P < .0001)
• Hypertension: 21.4% vs 20.6% (P = .32)
• Atrial fibrillation/flutter: 7.0% vs 5.8% (P = .01)
• Chronic kidney disease: 6.3% vs 2.4% (P < .0001)
• Liver disease: 1.3% vs 1.0% (P = .15)
• Diabetes: 16.6% vs 13.2% (P < .0001)

Prior to their hospitalization, the CS patients were also more likely to receive the following therapies:

• Antiplatelet drugs: 26.3% vs 25.1% (P = .14)
• Calcium channel blockers: 22.7% vs 19.5% (P < .0001)
• Angiotensin converting enzyme inhibitors/receptor blockers: 34.1% vs 29.5% (P < .0001)
• Beta-blockers: 18.4% vs 18.0% (P = .60)
• Mineralocorticoid-receptor agonists: 1.9% vs 1.7% (P = .57)
• Diuretics: 25.2% vs 23.5% (P = .03)
• Statins: 27.3% vs 23.3% (P < .0001)
• Antidiabetics: 13.9% vs 11.3% (P < .0001)

Most younger patients (< 50 years) admitted for MI and who had CS also had coronary angiography (92%) and percutaneous coronary intervention (60%) vs 56% and 42%, respectively, of older patients (≥ 80 years) (P < .0001 for all).

Overall, having CS was linked to a doubled 5-year rate of hospitalization for heart failure compared with not receiving the treatment: 40% vs 20% (adjusted HR [aHR], 2.90; 95% CI, 2.67-3.12). This increased risk was evident after the first year of follow-up, in that the rate was 3-fold higher (aHR, 3.25; 95% CI, 2.98-3.54) at that time: 21% (95% CI, 19%-22%) vs 7.8% (95% CI, 7.6%-7.9%).

In addition, all-cause mortality was shown to be elevated in the CS group vs the non-CS group at 1 year, at 18% (95% CI, 17%-20%) vs 8.1% (95% CI, 7.9%-8.3%) (aHR, 3.23; 95% CI, 2.95-3.54), but not in the 1-to-5-year analysis: 12% (95% CI, 11%-14%) vs 12.8% (95% CI, 12.6%-13.1%). This was despite a 1.15 aHR (95% CI, 1.00-1.33).

“Among MI hospital survivors, CS was associated with a markedly higher early and late rate of heart failure hospitalization compared with patients without CS,” the authors concluded. “In addition, the presence of CS was associated with increased 1-year all-cause mortality, whereas beyond the first year, mortality was similar for MI patients with and without CS.”

Long-term studies that investigate postdischarge survival and quality of life among patient who survive following hospitalization for heart failure are paramount, they stress, due to such data being sparse.

Reference

Lauridsen MD, Rorth R, Butt JH, et al. Five-year risk of heart failure and death following myocardial infarction with cardiogenic shock: a nationwide cohort study. Eur Heart J Acute Cardiovasc Care. Published online October 4, 2020. doi:10.1093/ehjacc/zuaa022