Document Detail

Prognosis in cardiogenic shock after acute myocardial infarction in the interventional era.
MedLine Citation:
PMID:  1452920     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The purpose of this study is to describe the outcome in cardiogenic shock treated with aggressive reperfusion therapy and to identify factors predictive of in-hospital and long-term mortality. BACKGROUND: Cardiogenic shock is the most common cause of death in patients admitted to the coronary care unit. Although studies have reported lower mortality rates in shock treated with angioplasty, few studies have described a cohort of patients with shock who were not selected because they were most likely to benefit from reperfusion therapy. METHODS: A consecutive series of 200 patients admitted with acute myocardial infarction complicated by cardiogenic shock were studied. RESULTS: The in-hospital mortality rate was 53%. Variables with significant univariable association with in-hospital death included patency of the infarct-related artery, patient age, lowest cardiac index, highest arteriovenous oxygen difference and left main coronary artery disease. The most important independent predictors of in-hospital death were patency of the infarct-related artery, cardiac index and peak creatine kinase, MB fraction. The mortality rate in patients with patent infarct-related arteries was 33% versus 75% in those with closed arteries and 84% in those in whom arterial patency was unknown. Patients who survived to hospital discharge were followed up for a median of 2 years, with a mortality rate of 18% after 1 year. The best descriptors of the relation between these variables and postdischarge mortality included age, peak creatine kinase, ejection fraction and patency of the infarct-related artery. CONCLUSIONS: In a large consecutive series of patients with cardiogenic shock with complete follow-up, patency of the infarct-related artery was most strongly associated with in-hospital and long-term mortality. This finding supports an aggressive interventional strategy in patients with cardiogenic shock.
J R Bengtson; A J Kaplan; K S Pieper; N M Wildermann; D B Mark; D B Pryor; H R Phillips; R M Califf
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  20     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1992 Dec 
Date Detail:
Created Date:  1992-12-31     Completed Date:  1992-12-31     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1482-9     Citation Subset:  AIM; IM    
Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710.
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MeSH Terms
Academic Medical Centers
Age Factors
Angioplasty, Transluminal, Percutaneous Coronary / standards
Cardiac Output
Cardiotonic Agents / therapeutic use
Combined Modality Therapy
Coronary Angiography
Creatine Kinase / blood
Decision Trees
Follow-Up Studies
Heart Catheterization
Hospital Mortality
Intra-Aortic Balloon Pumping / standards
Logistic Models
Middle Aged
Myocardial Infarction / complications*,  diagnosis
Myocardial Reperfusion / methods,  standards*
North Carolina / epidemiology
Predictive Value of Tests
Proportional Hazards Models
Prospective Studies
Shock, Cardiogenic / etiology,  mortality,  therapy*
Stroke Volume
Survival Analysis
Thrombolytic Therapy / standards
Treatment Outcome
Vasoconstrictor Agents / therapeutic use
Grant Support
Reg. No./Substance:
0/Cardiotonic Agents; 0/Isoenzymes; 0/Vasoconstrictor Agents; EC Kinase

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