Document Detail


Cardiogenic shock complicating acute myocardial infarction--etiologies, management and outcome: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK?
MedLine Citation:
PMID:  10985706     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This SHOCK Study report seeks to provide an overview of patients with cardiogenic shock (CS) complicating acute myocardial infarction (MI) and the outcome with various treatments. The outcome of patients undergoing revascularization in the SHOCK Trial Registry and SHOCK Trial are compared. BACKGROUND: Cardiogenic shock is the leading cause of death in patients hospitalized for acute MI. The randomized SHOCK Trial reported improved six-month survival with early revascularization. METHODS: Patients with CS complicating acute MI who were not enrolled in the concurrent randomized trial were registered. Patient characteristics were recorded as were procedures and vital status at hospital discharge. RESULTS: Between April 1993 and August 1997, 1,190 patients with CS were registered and 232 were randomized in the SHOCK Trial. Predominant left ventricular failure (78.5%) was most common, with isolated right ventricular shock in 2.8%, severe mitral regurgitation in 6.9%, ventricular septal rupture in 3.9% and tamponade in 1.4%. In-hospital Registry mortality was 60%, with ventricular septal rupture associated with a significantly higher mortality (87.3%) than all other categories (p < 0.01). The risk profile and mortality were lower for Registry patients who were managed with thrombolytic therapy and/or intra-aortic balloon counter-pulsation, coronary angiography, angioplasty and/or coronary artery bypass surgery. After adjusting for these differences, the extent to which survival was improved with early revascularization was similar to that observed in the randomized SHOCK Trial. CONCLUSIONS: In this prospective Registry the etiology of CS was a mechanical complication in 12%. The similarity of the beneficial treatment effect in patients undergoing early revascularization in the SHOCK Trial Registry and SHOCK Trial provides strong support for the generalizability of the SHOCK Trial results.
Authors:
J S Hochman; C E Buller; L A Sleeper; J Boland; V Dzavik; T A Sanborn; E Godfrey; H D White; J Lim; T LeJemtel
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; 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:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1063-70     Citation Subset:  AIM; IM    
Affiliation:
St. Luke's-Roosevelt Hospital Center and Columbia University, New York, New York, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Angiography
Diagnosis, Differential
Female
Heart Catheterization
Humans
Incidence
Intra-Aortic Balloon Pumping*
Male
Myocardial Infarction / complications,  diagnosis,  mortality,  therapy
Myocardial Revascularization*
Prospective Studies
Radionuclide Ventriculography
Registries* / statistics & numerical data
Shock, Cardiogenic / diagnosis,  epidemiology,  etiology*,  therapy
Survival Rate
Thrombolytic Therapy*
Treatment Outcome
Grant Support
ID/Acronym/Agency:
R01-HL49970/HL/NHLBI NIH HHS; R01-HL50020-018Z/HL/NHLBI NIH HHS

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


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