| Systemic inflammatory response syndrome after acute myocardial infarction complicated by cardiogenic shock. | |
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MedLine Citation:
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PMID: 16043684 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The role of inflammation in patients with coronary artery disease is emerging. We sought to assess the profile and outcomes of patients with a clinical syndrome of severe systemic inflammation that led to a diagnosis of suspected sepsis in the setting of acute myocardial infarction complicated by cardiogenic shock (CS). METHODS: Patients enrolled in the randomized SHOCK (SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK) trial (n = 302) were divided into those with clinical signs of severe systemic inflammation (eg, fever [94%] or leukocytosis [72%]) that led to a diagnosis of suspected sepsis (n = 54 [18%]) and those without suspected sepsis (controls; n = 243 [80%]). The patients with suspected sepsis were then further subdivided into those who were considered to be potentially infectious (positive culture result ["culture-positive"]; n = 40) and those who were not (negative culture result ["culture-negative"]; n = 14). RESULTS: Severe systemic inflammation was diagnosed 4 and 2 days after the onset of CS in culture-positive and culture-negative patients, respectively. Patients who developed systemic inflammation tended to be younger (P = .05) and to have lower systemic vascular resistance (SVR) near the onset of CS (P = .006). Many culture-positive patients (40%) had undergone coronary artery bypass graft surgery. However, the lower the initial SVR, the higher the risk of developing culture-positive systemic inflammation (P = .01), even after controlling for age and coronary artery bypass graft surgery. A time-dependent model, adjusted for age, showed that culture-positive patients were at significantly higher risk for death than were controls (hazard ratio, 2.22; 95% confidence interval, 1.32-3.76; P = .008). CONCLUSIONS: Almost one fifth of patients with acute myocardial infarction complicated by CS showed clinical signs of severe systemic inflammation, and those who were culture-positive for sepsis had twice the risk of death. The observation of lower SVR at the onset of shock in patients who subsequently had culture-positive systemic inflammation suggests that inappropriate vasodilation may play an important role in the pathogenesis and persistence of shock and in the risk of infection. |
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Authors:
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Shun Kohsaka; Venu Menon; April M Lowe; Michael Lange; Vladimir Dzavik; Lynn A Sleeper; Judith S Hochman; |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Archives of internal medicine Volume: 165 ISSN: 0003-9926 ISO Abbreviation: Arch. Intern. Med. Publication Date: 2005 Jul |
Date Detail:
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Created Date: 2005-07-26 Completed Date: 2005-08-25 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0372440 Medline TA: Arch Intern Med Country: United States |
Other Details:
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Languages: eng Pagination: 1643-50 Citation Subset: AIM; IM |
Affiliation:
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Department of Cardiology, Texas Heart Institute at St Luke's Episcopal Hospital and Baylor College of Medicine, Houston, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Age Factors Aged Case-Control Studies Coronary Artery Bypass Female Humans Logistic Models Male Middle Aged Myocardial Infarction / complications*, surgery Randomized Controlled Trials as Topic Risk Assessment Risk Factors Shock, Cardiogenic / etiology*, mortality, surgery Systemic Inflammatory Response Syndrome / complications*, etiology, mortality Time Factors |
| Grant Support | |
ID/Acronym/Agency:
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R01 HL49970/HL/NHLBI NIH HHS; R01 HL50020/HL/NHLBI NIH HHS |
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