Document Detail


Cardiogenic shock complicating acute myocardial infarction in patients without heart failure on admission: incidence, risk factors, and outcome. SPRINT Study Group.
MedLine Citation:
PMID:  8452150     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Patients with large myocardial infarction (MI) presenting with clinical signs of heart failure are at increased risk for subsequent development of cardiogenic shock and death. Little is known, however, about the development of cardiogenic shock among patients with acute MI presenting without clinical signs of heart failure. The aim of the present study was to examine the incidence, predictors for occurrence, and outcome of in-hospital development of cardiogenic shock among patients with acute MI without heart failure on admission. PATIENTS AND METHODS: Clinical data of 5,839 consecutive patients hospitalized with acute MI were analyzed. RESULTS: Of 3,465 (59%) patients without heart failure on admission (Killip class I), 89 (2.6%) developed cardiogenic shock during their hospital stay. This represented 24% of all cases of in-hospital cardiogenic shock in the entire group. Cardiogenic shock developed more than 24 hours after admission in 66% of cases. All but three patients with cardiogenic shock died whereas a 5% in-hospital mortality was found among patients without cardiogenic shock. Independent predictors for in-hospital shock were age (for a 10-year increment, adjusted relative odds [RO] = 2.45, 90% confidence interval [CI] = 1.50 to 4.02); female gender (RO = 1.51, 90% CI = 0.91 to 2.50); history of angina (RO = 2.64, 90% CI = 1.36 to 3.76); history of stroke (RO = 2.12, 90% CI = 1.26 to 6.35); peripheral vascular disease (RO = 1.99, 90% CI = 0.95 to 4.18); peak lactate dehydrogenase (LDH) greater than four times the normal (RO = 3.16, 90% CI = 1.79 to 5.57); and hyperglycemia on admission (RO = 3.52, 90% CI = 2.13 to 5.84). Patients with six risk factors (excluding LDH values) had an estimated probability of 35% for developing in-hospital cardiogenic shock. CONCLUSIONS: (1) A significant proportion of MI patients who developed cardiogenic shock during hospitalization were free of heart failure on admission. (2) Our study identified several risk factors facilitating early identification of subgroups at risk for cardiogenic shock within otherwise low-risk patients.
Authors:
J Leor; U Goldbourt; H Reicher-Reiss; E Kaplinsky; S Behar
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of medicine     Volume:  94     ISSN:  0002-9343     ISO Abbreviation:  Am. J. Med.     Publication Date:  1993 Mar 
Date Detail:
Created Date:  1993-04-13     Completed Date:  1993-04-13     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  265-73     Citation Subset:  AIM; IM    
Affiliation:
SPRINT Coordinating Center, Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel.
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Analysis of Variance
Cardiology Service, Hospital / statistics & numerical data
Female
Hospital Mortality
Humans
Incidence
Male
Middle Aged
Myocardial Infarction / complications
Risk Factors
Shock, Cardiogenic / epidemiology*,  etiology*,  therapy
Time Factors

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