Trends in cardiogenic shock management and prognostic impact of type of treating center
Por:
Sanchez-Salado, JC, Burgos, V, Ariza-Sol, A, Sionis, A, Canteli, A, Bernal, JL, Fernandez, C, Castrillo, C, Ruiz-Lera, M, Lopez-de-Sa, E, Lidon, RM, Worner, F, Martinez-Selles, M, Segovia, J, Viana-Tejedor, A, Lorente, V, Alegre, O, Llao, I, Gonzalez-Costello, J, Manito, N, Cequier, A, Bueno, H, Elola, J
Publicada:
1 jul 2020
Resumen:
Introduction and objectives: Current guidelines recommend centralizing the care of patients with cardiogenic shock in high-volume centers. The aim of this study was to assess the association between hospital characteristics, including the availability of an intensive cardiac care unit, and outcomes in patients with ST-segment elevation myocardial infarction (STEMI)-related cardiogenic shock (CS).
Methods: Discharge episodes with a diagnosis of STEMI-related CS between 2003 and 2015 were selected from the Minimum Data Set of the Spanish National Health System. Centers were classified according to the availability of a cardiology department, catheterization laboratory, cardiac surgery department, and intensive cardiac care unit. The main outcome measured was in-hospital mortality.
Results: A total of 19 963 episodes were identified. The mean age was 73.4 +/- 11.8 years. The proportion of patients with CS treated at hospitals with a catheterization laboratory and cardiac surgery department increased from 38.4% in 2005 to 52.9% in 2015 (P < .005). Crude- and risk-adjusted mortality rates decreased over time, from 82% to 67.1%, and from 82.7% to 66.8%, respectively (both P < .001). Coronary revascularization, either percutaneous or coronary artery bypass grafting, was independently associated with a lower mortality risk (OR, 0.29 and 0.25; both P < .001, respectively). Intensive cardiac care unit availability was associated with lower adjusted mortality rates (65.3% +/- 7.9 vs 72 +/- 11.7; P < .001).
Conclusions: The proportion of patients with STEMI-related CS treated at highly specialized centers increased while mortality decreased during the study period. Better outcomes were associated with the increased performance of revascularization procedures and access to intensive cardiac care units over time. (C) 2019 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.
Filiaciones:
Sanchez-Salado, JC:
Hosp Univ Bellvitge, Serv Cardiol, Unidad Cuidados Intens Cardiol, Barcelona, Spain
Burgos, V:
Hosp Marques Valdecilla, Serv Cardiol, Unidad Cuidados Intens Cardiol, Santander, Spain
Ariza-Sol, A:
Hosp Univ Bellvitge, Serv Cardiol, Unidad Cuidados Intens Cardiol, Barcelona, Spain
Sionis, A:
Univ Autdnoma Barcelona, Hosp Santa Creu & St Pau, IIB St Pau, Unidad Cuidados Intens Cardiol,Serv Cardiol,CIBER, Barcelona, Spain
Canteli, A:
Hosp Marques Valdecilla, Serv Cardiol, Unidad Cuidados Intens Cardiol, Santander, Spain
Bernal, JL:
Fdn Inst Mejora Asistencia Sanitaria, Madrid, Spain
Hosp Univ 12 Octubre, CIBER CV, Serv Control Gest, Madrid, Spain
Fernandez, C:
Fdn Inst Mejora Asistencia Sanitaria, Madrid, Spain
Univ Complutense Madrid, Hosp Clin Univ San Carlos, Serv Med Prevent, Madrid, Spain
Castrillo, C:
Hosp Marques Valdecilla, Serv Cardiol, Unidad Cuidados Intens Cardiol, Santander, Spain
Ruiz-Lera, M:
Hosp Marques Valdecilla, Serv Cardiol, Unidad Cuidados Intens Cardiol, Santander, Spain
Lopez-de-Sa, E:
Hosp Univ La Paz, IDIPAZ, CIBER CV, Unidad Cuidados Intens Cardiol,Serv Cardiol, Madrid, Spain
Lidon, RM:
Hosp Univ Vali dHebron, IDIPAZ, CIBER CV, Unidad Cuidados Intens Cardiol,Serv Cardiol, Madrid, Spain
Worner, F:
Hosp Arnau Vilanova, Serv Cardiol, IRBLLEIDA, Lleida, Spain
Martinez-Selles, M:
Univ Complutense, Univ Europea, Hosp Gen Univ Gregorio Maranon, Unidad Cuidados Intens Cardiol Serv Cardiol,CIBER, Madrid, Spain
Segovia, J:
Hosp Puerta Hierro, Unidad Insuficiencia Cardiaca Avanzada & Trasplan, Madrid, Spain
Viana-Tejedor, A:
Univ Complutense Madrid, Hosp Clin Univ San Carlos, Serv Cardiol, Unidad Cuidados Intens Cardiol, Madrid, Spain
Lorente, V:
Hosp Univ Bellvitge, Serv Cardiol, Unidad Cuidados Intens Cardiol, Barcelona, Spain
Alegre, O:
Hosp Univ Bellvitge, Serv Cardiol, Unidad Cuidados Intens Cardiol, Barcelona, Spain
Llao, I:
Hosp Univ Bellvitge, Serv Cardiol, Unidad Cuidados Intens Cardiol, Barcelona, Spain
Gonzalez-Costello, J:
Hosp Univ Bellvitge, Serv Cardiol, Unidad Insuficiencia Cardiaca Avanzada & Trasplan, Barcelona, Spain
Manito, N:
Hosp Univ Bellvitge, Serv Cardiol, Unidad Insuficiencia Cardiaca Avanzada & Trasplan, Barcelona, Spain
Cequier, A:
Hosp Univ Bellvitge, Serv Cardiol, Barcelona, Spain
Bueno, H:
Hosp Univ 12 Octubre, CIBER CV, Serv Cardiol, Unidad Cuidados Intens Cardiol, Madrid, Spain
Ctr Nacl Invest Cardiovasc, Madrid, Spain
Elola, J:
Fdn Inst Mejora Asistencia Sanitaria, Madrid, Spain
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