Document Detail

Systemic inflammatory response syndrome after acute myocardial infarction complicated by cardiogenic shock.
MedLine Citation:
PMID:  16043684     Owner:  NLM     Status:  MEDLINE    
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.
Shun Kohsaka; Venu Menon; April M Lowe; Michael Lange; Vladimir Dzavik; Lynn A Sleeper; Judith S Hochman;
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Archives of internal medicine     Volume:  165     ISSN:  0003-9926     ISO Abbreviation:  Arch. Intern. Med.     Publication Date:  2005 Jul 
Date Detail:
Created Date:  2005-07-26     Completed Date:  2005-08-25     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1643-50     Citation Subset:  AIM; IM    
Department of Cardiology, Texas Heart Institute at St Luke's Episcopal Hospital and Baylor College of Medicine, Houston, USA.
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MeSH Terms
Age Factors
Case-Control Studies
Coronary Artery Bypass
Logistic Models
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

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