Document Detail


Angiographic findings and clinical correlates in patients with cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK?
MedLine Citation:
PMID:  10985708     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We sought to delineate the angiographic findings, clinical correlates and in-hospital outcomes in patients with cardiogenic shock (CS) complicating acute myocardial infarction. BACKGROUND: Patients with CS complicating acute myocardial infarction carry a grave prognosis. Detailed angiographic findings in a large, prospectively identified cohort of patients with CS are currently lacking. METHODS: We compared the clinical characteristics, angiographic findings, and in-hospital outcomes of 717 patients selected to undergo angiography and 442 not selected, overall and by shock etiology: left or right ventricular failure versus mechanical complications. RESULTS: Patients who underwent angiography had lower baseline risk and a better hemodynamic profile than those who did not. Overall, 15.5% of the patients had significant left main lesions on angiography, and 53.4% had three-vessel disease, with higher rates of both for those with ventricular failure, compared with patients who had mechanical complications. Among patients who underwent angiography, those with ventricular failure had significantly lower in-hospital mortality than patients with mechanical complications (45.2% vs. 57.0%; p = 0.021). Importantly, for patients with ventricular failure, in-hospital mortality also correlated with disease severity: 35.0% for no or single-vessel disease versus 50.8% for three-vessel disease. Furthermore, mortality was associated with the culprit lesion location (78.6% in left main lesion, 69.7% in saphenous vein graft lesions, 42.4% in circumflex lesions, 42.3% in left anterior descending lesions, and 37.4% in right coronary artery lesions), and Thrombolysis In Myocardial Infarction (TIMI) flow grade (46.5% in TIMI 0/1, 49.4% in TIMI 2 and 26% in TIMI 3). CONCLUSIONS: Patients who underwent angiographic study in the SHOCK Trial Registry had a more benign cardiac risk profile, more favorable hemodynamic findings and lower in-hospital mortality than those for whom angiograms were not obtained. Patients with CS caused by ventricular failure had more severe atherosclerosis, and a different distribution of culprit vessel involvement but lower in-hospital mortality, than those with mechanical complications. Overall in-hospital survival correlates with the extent of coronary artery obstructions, location of culprit lesion and baseline coronary TIMI flow grade.
Authors:
S C Wong; T Sanborn; L A Sleeper; J G Webb; R Pilchik; D Hart; S Mejnartowicz; T A Antonelli; R Lange; J K French; G Bergman; T LeJemtel; J S Hochman
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  36     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2000 Sep 
Date Detail:
Created Date:  2000-09-26     Completed Date:  2000-09-26     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1077-83     Citation Subset:  AIM; IM    
Affiliation:
Department of Internal Medicine, the New York Hospital-Cornell Medical Center, New York, USA. scwong@med.cornell.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Blood Flow Velocity
Coronary Angiography*
Coronary Circulation
Female
Heart Failure / complications,  physiopathology,  radiography,  therapy
Hospital Mortality
Humans
Male
Myocardial Infarction / complications,  physiopathology,  radiography,  therapy
Myocardial Revascularization
Prospective Studies
Registries*
Severity of Illness Index
Shock, Cardiogenic / etiology,  mortality,  radiography*,  therapy
Thrombolytic Therapy
Ventricular Dysfunction, Left / complications,  physiopathology,  radiography,  therapy
Grant Support
ID/Acronym/Agency:
R01 HL49970/HL/NHLBI NIH HHS; R01 HL50020/HL/NHLBI NIH HHS

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