Document Detail


Acute myocardial infarction complicated by systemic hypoperfusion without hypotension: report of the SHOCK trial registry.
MedLine Citation:
PMID:  10759093     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Cardiogenic shock is usually characterized by inadequate cardiac output and sustained hypotension. However, following a large myocardial infarction, peripheral hypoperfusion can occur with relatively well maintained systolic blood pressure, a condition known as nonhypotensive cardiogenic shock. The aim of this study was to determine the characteristics of patients with this condition. METHODS: The SHOCK trial registry prospectively enrolled patients with suspected cardiogenic shock complicating acute myocardial infarction. We identified a group of 49 patients who presented with nonhypotensive shock, defined as clinical evidence of peripheral hypoperfusion with a systolic blood pressure >90 mm Hg without vasopressor circulatory support. Clinical characteristics, hemodynamic data, and outcomes in these patients were compared with a group of 943 patients with classic cardiogenic shock with hypotension. The age, gender, and distributions of coronary risk factors were similar in both groups. RESULTS: Patients with nonhypotensive shock were more likely to have an anterior wall myocardial infarction (71% versus 53%, P = 0.03). Both groups of patients had similar rates of treatment with thrombolytic therapy, angioplasty, and bypass surgery. Patients with nonhypotensive shock had an in-hospital mortality rate of 43% as compared with a rate of 66% among patients who had classic cardiogenic shock with hypotension (P = 0.001). Mortality among 76 patients who presented with a systolic blood pressure <90 mm Hg but no hypoperfusion was 26%. CONCLUSIONS: Even in the presence of normal blood pressure, clinical signs of peripheral hypoperfusion, which may be subtle, are associated with a substantial risk of in-hospital death following acute myocardial infarction.
Authors:
V Menon; J N Slater; H D White; L A Sleeper; T Cocke; J S Hochman
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The American journal of medicine     Volume:  108     ISSN:  0002-9343     ISO Abbreviation:  Am. J. Med.     Publication Date:  2000 Apr 
Date Detail:
Created Date:  2000-04-21     Completed Date:  2000-04-21     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  374-80     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, St. Luke's-Roosevelt Hospital Center, Columbia University, New York, New York 10025, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Clinical Trials as Topic
Female
Hemodynamics*
Hospital Mortality
Humans
Hypotension / etiology
Male
Middle Aged
Myocardial Infarction / complications*,  mortality,  physiopathology*,  therapy
Prospective Studies
Registries
Shock, Cardiogenic / etiology*,  mortality,  physiopathology*,  therapy
Grant Support
ID/Acronym/Agency:
HL49970/HL/NHLBI NIH HHS; HL50020/HL/NHLBI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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