TY - JOUR 
A1 - Sánchez-Salado, José Carlos
AU - Burgos, Virginia
AU - Ariza Solé, Albert
AU - Sionis, Alessandro
AU - Canteli, Ángela
AU - Bernal, José Luis
AU - Fernández Pérez, Cristina
AU - Castrillo, Cristina
AU - Martínez Sellés Oliveria Soares, Manuel
AU - Elola, Francisco Javier
AU - Et al.
T1 - Trends in cardiogenic shock management and prognostic impact of type of treating center

Y1 - 2020
SN - 0300-8932

UR - http://hdl.handle.net/11268/8847
AB - 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.
KW - Cáncer
KW - Tratamiento médico
KW - Unidades de cuidados intensivos
KW - Cáncer
KW - Tratamiento médico
KW - Hospital
LA - eng
ER -