Document Detail


Trends in cardiogenic shock: report from the SHOCK Study. The SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK?
MedLine Citation:
PMID:  11237542     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: We analysed time trends in patient characteristics, management, and outcomes of cardiogenic shock complicating acute myocardial infarction in the international, prospective SHOCK Trial Registry and pre-study Registry. BACKGROUND: Despite therapeutic advances in its management, the incidence and high mortality of this complication has remained unchanged for decades. However, in recent years mortality was reported to decrease in one community concomitant with increasing use of revascularization. METHODS: Thirty-six centres registered 1380 patients with suspected cardiogenic shock complicating acute myocardial infarction from January 1992 to August 1997. Patient and myocardial infarction characteristics, haemodynamics, medications, procedure use, and vital status at discharge were recorded. RESULTS: In all, 79% of patients had shock due to predominant pump failure (non-mechanical aetiology). The aetiology, patient profile, and clinical characteristics of cardiogenic shock did not differ over time, except for increases in the incidence of prior bypass surgery (P=0.054) and transfers to tertiary centres (P=0.008). In all, 44% underwent revascularization (n=485), with angioplasty performed more often than bypass surgery (69% vs 31%). The revascularization rate increased over time (P=0.006) with a significant decrease in the time to revascularization (P=0.033). The use of Swan-Ganz catheterization decreased over time (P=0.018), as did the mean length of hospitalization (P=0.034). Overall in-hospital mortality was high (63%) but decreased over time in all patients (P=0.004) and those with pump failure (P=0.018). Mortality was lower for patients who underwent revascularization compared to those who were not revascularized (41% vs 79%, P<0.001). CONCLUSIONS: Cardiogenic shock complicating acute myocardial infarction is associated with a high mortality rate, but mortality decreased significantly from 1992 to 1997. This partly reflects the greater use of revascularization, which was associated with better outcomes. The reported international trend towards shorter admissions for myocardial infarction was also observed in this cohort.
Authors:
L Carnendran; R Abboud; L A Sleeper; R Gurunathan; J G Webb; V Menon; V Dzavik; T Cocke; J S Hochman
Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  European heart journal     Volume:  22     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2001 Mar 
Date Detail:
Created Date:  2001-03-12     Completed Date:  2001-05-17     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  472-8     Citation Subset:  IM    
Affiliation:
St. Luke's-Roosevelt Hospital Center, Columbia University, New York, New York 10025, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Emergencies
Humans
Length of Stay
Middle Aged
Myocardial Infarction / complications*,  surgery*
Myocardial Revascularization*
Prognosis
Prospective Studies
Registries
Shock, Cardiogenic / etiology,  mortality*
Survival Analysis
Grant Support
ID/Acronym/Agency:
R01 HL49970/HL/NHLBI NIH HHS; R01 HL50020-018Z/HL/NHLBI NIH HHS
Comments/Corrections
Comment In:
Eur Heart J. 2001 Mar;22(6):444-5   [PMID:  11237536 ]

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