| Predictors of 30-day mortality in patients with refractory cardiogenic shock following acute myocardial infarction despite a patent infarct artery. | |
| | |
MedLine Citation:
|
PMID: 19781431 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: Little is known about predictors of survival in patients with persistent shock following acute myocardial infarction (MI) despite a patent infarct artery. METHODS: We examined data from TRIUMPH, a multicenter randomized clinical trial of the nitric oxide synthase inhibitor, L-N(G)-monomethyl-arginine, in patients with persistent vasopressor-dependent cardiogenic shock complicating acute MI at least 1 hour after established infarct-related artery patency. Patients who died within 30 days were compared with those who survived. Continuous variables were assessed using the Wilcoxon rank sum and categorical variables using the chi(2) test. Prespecified baseline variables were included in a multivariable logistic regression model to predict mortality. A second model incorporating baseline vasopressors and dosages and a third model including change in systolic blood pressure at 2 hours were also developed. Bootstrapping was used to assess the stability of model variables. RESULTS: Of 396 patients, 180 (45.5%) died within 30 days. Systolic blood pressure (SBP), measured on vasopressor support, and creatinine clearance were significant predictors of mortality in all models. The number of vasopressors and norepinephrine dose were also predictors of mortality in the second model, but the latter was no longer significant when change in SBP at 2 hours was added as a covariate in the third model. CONCLUSIONS: The SBP, creatinine clearance, and number of vasopressors are significant predictors of mortality in patients with persistent vasopressor-dependent cardiogenic shock following acute MI despite a patent infarct artery. These prognostic variables may be useful for risk-stratification and in selecting patients for investigation of additional therapies. |
| | |
Authors:
|
Jason N Katz; Amanda L Stebbins; John H Alexander; Harmony R Reynolds; Karen S Pieper; Witold Ruzyllo; Karl Werdan; Alexander Geppert; Vladimir Dzavik; Frans Van de Werf; Judith S Hochman; |
Publication Detail:
|
Type: Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial |
Journal Detail:
|
Title: American heart journal Volume: 158 ISSN: 1097-6744 ISO Abbreviation: Am. Heart J. Publication Date: 2009 Oct |
Date Detail:
|
Created Date: 2009-09-28 Completed Date: 2009-10-20 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 0370465 Medline TA: Am Heart J Country: United States |
Other Details:
|
Languages: eng Pagination: 680-7 Citation Subset: AIM; IM |
Affiliation:
|
University of North Carolina School of Medicine, Chapel Hill, NC 27599-7875, USA. Jason_Katz@med.unc.edu |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Aged Arginine / administration & dosage, analogs & derivatives* Coronary Vessels / physiopathology* Dose-Response Relationship, Drug Double-Blind Method Drug Therapy, Combination Europe / epidemiology Female Follow-Up Studies Humans Male Middle Aged Myocardial Infarction / complications*, drug therapy, physiopathology Nitric Oxide Synthase / antagonists & inhibitors Norepinephrine / administration & dosage* Ontario / epidemiology Prognosis Prospective Studies Shock, Cardiogenic / etiology, mortality*, prevention & control Survival Rate / trends Time Factors United States / epidemiology Vascular Patency / physiology* Vasoconstrictor Agents / administration & dosage |
| Chemical | |
Reg. No./Substance:
|
0/N(G)-monomethylarginine acetate; 0/Vasoconstrictor Agents; 51-41-2/Norepinephrine; 74-79-3/Arginine; EC 1.14.13.39/Nitric Oxide Synthase |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Prevalence and prognostic significance of incidental cardiac troponin T elevation in ambulatory pati...
Next Document: Characterization and outcomes of women and men with non-ST-segment elevation myocardial infarction a...