It remains uncertain whether the sweeping changes in the treatment of acute coronary syndromes have had a substantial impact on the incidence of cardiogenic shock.

The AMIS (Acute Myocardial Infarction in Switzerland) Plus Registry analysed registry data from patients admitted to Swiss hospitals between 1997 and 2006.  23696 patients with acute coronary syndromes were enlisted.  Although the rate of cardiogenic shock on admission remained constant at 2.3% in patients with ACS, rates of cardiogenic shock during hospitalization decreased to 6.0%, leading to an overall decrease in the rate of cardiogenic shock to 8.3% of all patients with ACS.  Overall, a decrease in in-hospital mortality was also seen (62.8% to 47.7%; p=0.01), and percutaneous coronary intervention was independently associated with a lower risk for both in-hospital mortality (odds ratio, 0.47; p=0.001) and cardiogenic shock development during admission (odds ratio, 0.59; p=0.012).

Therefore both the incidence and mortality from cardiogenic shock appears to be declining in this select population.  It should be noted that a higher rate of shock and mortality was seen in patients aged over 75 (p<0.001), but that these patients also received fewer therapies (thrombolytics, percutaneous coronary intervention, and intra-aortic ballon counterpulsation).  The findings therefore underline the importance of following treatment guidelines in patients of all ages.

• Jeger RV, Radovanovic D, Hunziker PR et al.  Ten-Year Trends in the Incidence and Treatment of Cardiogenic Shock. Ann Int Med 2008:149(9):618-626