Document Detail


Cardiogenic shock developing in the coronary care unit in patients with ST-elevation myocardial infarction.
MedLine Citation:
PMID:  18799965     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: A relevant proportion of patients with ST-segment elevation myocardial infarction may develop cardiogenic shock after presentation, and the identification of these patients would be very important in order to improve their outcome. The aim of the current study was to identify, among patients in the BLITZ-1, the clinical predictors, and describe the outcome of patients who developed cardiogenic shock during hospitalization. METHODS: The study was a nationwide survey of patients admitted to a coronary care units for an acute myocardial infarction with or without ST-segment elevation myocardial infarction in October 2001. The 30-day follow-up was conducted by hospital visits and concerned major cardiac events occurred from hospital discharge. RESULTS: A total of 1345 patients presenting with ST-segment elevation myocardial infarction or left bundle branch block/pacemaker were included in this analysis. A total of 97 patients (7.2%) had cardiogenic shock, 26 patients at presentation, whereas 71 patients (73.2%) developed shock during hospital stay. Mortality was 71.8% among patients who developed cardiogenic shock during hospitalization as compared with 65.4% among those who were already in shock upon admission (P = 0.54). By multivariable analysis, we identified Killip class more than 1, lower systolic blood pressure at presentation, older age, unsuccessful reperfusion and diabetes as independent predictors of developing shock during hospitalization. CONCLUSION: The present study shows that the largest proportion of cardiogenic shock complicating ST-segment elevation myocardial infarction is observed after initial hospitalization, particularly in patients with Killip class more than 1, low systolic blood pressure at presentation and advanced age. The identification of these patients may help in preventing this complication by more aggressive pharmacological therapies, mechanical haemodynamic support, as well as coronary revascularization.
Authors:
Giuseppe De Luca; Stefano Savonitto; Cesare Greco; Guido Parodi; Nevio C Dajelli Ermolli; Caterina Silva; Donata Lucci; Lucio Gonzini; Aldo P Maggioni; Claudio Cuccia;
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of cardiovascular medicine (Hagerstown, Md.)     Volume:  9     ISSN:  1558-2027     ISO Abbreviation:  J Cardiovasc Med (Hagerstown)     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-09-18     Completed Date:  2008-10-30     Revised Date:  2009-05-28    
Medline Journal Info:
Nlm Unique ID:  101259752     Medline TA:  J Cardiovasc Med (Hagerstown)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1023-9     Citation Subset:  IM    
Affiliation:
Division of Cardiology, 'Maggiore della Carità' Hospital, Eastern Piedmont University 'A. Avogadro', and Centro di Biotecnologie per la Ricerca Medica Applicata (BRMA), Novara, Italy. giuseppe.deluca@med.unipmn.it
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Aged, 80 and over
Coronary Angiography
Coronary Care Units*
Diabetes Complications / etiology
Female
Health Care Surveys
Hospital Mortality
Humans
Hypotension / complications
Italy
Male
Middle Aged
Myocardial Infarction / complications*,  mortality,  radiography,  therapy
Myocardial Reperfusion / adverse effects
Risk Factors
Severity of Illness Index
Shock, Cardiogenic / etiology*,  mortality,  prevention & control,  radiography
Time Factors
Treatment Failure

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