Document Detail


Correlates of one-year survival inpatients with cardiogenic shock complicating acute myocardial infarction: angiographic findings from the SHOCK trial.
MedLine Citation:
PMID:  14563577     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The goal of this study was to describe the core laboratory angiographic findings of "SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK" (SHOCK) trial participants and to determine the relationship of angiographic parameters to one-year survival. BACKGROUND: In the SHOCK trial, emergency revascularization improved one-year survival of patients with cardiogenic shock compared with initial medical stabilization including thrombolysis and intraaortic balloon counterpulsation. METHODS: Coronary angiography was performed by protocol in 147 of 152 (97%) patients in the emergency revascularization (ERV) group and by clinical selection in 100 of 150 (67%) patients in the initial medical stabilization (IMS) group. Of the other 50 IMS patients, 45 of 50 (90%) died rapidly and did not undergo angiography. RESULTS: Left ventricular ejection fraction was correlated with one-year survival in both treatment groups (p < 0.001). In the IMS group, the hazard ratio for death was 2.59 (95% confidence interval 1.47 to 4.58, p = 0.001) per diseased vessel (0/1 vs. 2 vs. 3). In the ERV group, the hazard ratio for death per diseased vessel was 1.11 (95% confidence interval 0.79 to 1.56, p = 0.559). Multivariate analysis of the angiography cohort (without regard for left ventriculogram measurements) identified initial Thrombolysis in Myocardial Infarction flow grade (p = 0.032), number of diseased vessels (for IMS patients only, p = 0.024), and culprit vessel (p = 0.004) as independent correlates of one-year survival, even after adjustment for key clinical factors. In the smaller cohort with left ventricular ejection fraction measured (n = 97), ejection fraction and culprit vessel remained independently correlated with survival. CONCLUSIONS: For patients in cardiogenic shock, left ventricular function and culprit vessel were independent correlates of one-year survival.
Authors:
Timothy A Sanborn; Lynn A Sleeper; John G Webb; John K French; Geoffrey Bergman; Manish Parikh; S Chiu Wong; Jean Boland; Matthias Pfisterer; James N Slater; Samin Sharma; Judith S Hochman;
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Publication Detail:
Type:  Clinical Trial; 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:  42     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2003 Oct 
Date Detail:
Created Date:  2003-10-17     Completed Date:  2003-11-07     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:  1373-9     Citation Subset:  AIM; IM    
Affiliation:
Evanston Northwestern Healthcare, Evanston, Illinois 60201, USA. tsanorn@enh.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Angiography*
Female
Humans
Intra-Aortic Balloon Pumping
Male
Multivariate Analysis
Myocardial Infarction / complications
Myocardial Revascularization*
Proportional Hazards Models
Shock, Cardiogenic / mortality*,  radiography,  therapy*
Thrombolytic Therapy
Ventricular Function, Left / physiology
Grant Support
ID/Acronym/Agency:
R01-HL-49970/HL/NHLBI NIH HHS; R01-HL-50020/HL/NHLBI NIH HHS
Comments/Corrections
Comment In:
J Am Coll Cardiol. 2003 Oct 15;42(8):1387-8   [PMID:  14563579 ]

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


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