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Cardiogenic shock due to acute severe mitral regurgitation complicating acute myocardial infarction: a report from the SHOCK Trial Registry. SHould we use emergently revascularize Occluded Coronaries in cardiogenic shocK?
MedLine Citation:
PMID:  10985712     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Our objective was to define the outcomes of patients with cardiogenic shock (CS) due to severe mitral regurgitation (MR) complicating acute myocardial infarction (AMI). BACKGROUND: Methods for early identification and optimal treatment of such patients have not been defined. METHODS: The SHOCK Trial Registry enrolled 1,190 patients with CS complicating AMI. We compared 1) the cohort with severe mitral regurgitation (MR, n = 98) to the cohort with predominant left ventricular failure (LVF, n = 879), and 2) the MR patients who underwent valve surgery (n = 43) to those who did not (n = 51). RESULTS: Shock developed early after MI in both the MR (median 12.8 h) and LVF (median 6.2 h) cohorts. The MR patients were more often female (52% vs. 37%, p = 0.004) and less likely to have ST elevation at shock diagnosis (41% vs. 63%, p < 0.001). The MR index MI was more frequently inferior (55% vs. 44%, p = 0.039) or posterior (32% vs. 17%, p = 0.002) than that of LVF and much less frequently anterior (34% vs. 59%, p < 0.001). Despite having higher mean LVEF (0.37 vs. 0.30, p = 0.001) the MR cohort had similar in-hospital mortality (55% vs. 61%, p = 0.277). The majority of MR patients did not undergo mitral valve surgery. Those undergoing surgery exhibited higher mean LVEF than those not undergoing surgery; nevertheless, 39% died in hospital. CONCLUSIONS: The data highlight opportunities for early identification and intervention to potentially decrease the devastating mortality and morbidity of severe post-myocardial infarction MR.
Authors:
C R Thompson; C E Buller; L A Sleeper; T A Antonelli; J G Webb; W A Jaber; J G Abel; J S Hochman
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:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1104-9     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada. cthompson@Providencehealth.bc.ca
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MeSH Terms
Descriptor/Qualifier:
Aged
Balloon Dilatation
Coronary Angiography
Female
Heart Valve Prosthesis Implantation
Hospital Mortality
Humans
Male
Middle Aged
Mitral Valve Insufficiency / complications*,  physiopathology,  therapy
Myocardial Infarction / complications,  physiopathology,  radiography,  therapy
Myocardial Revascularization
Odds Ratio
Prospective Studies
Registries*
Shock, Cardiogenic / etiology*,  mortality,  physiopathology,  therapy
Stroke Volume
Survival Rate
Grant Support
ID/Acronym/Agency:
HL 50020-018Z/HL/NHLBI NIH HHS; HL-49970/HL/NHLBI NIH HHS

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