Current Spectrum of Cardiogenic Shock and Effect of Early Revascularization on Mortality

• DOI: 10.1161/01.cir.91.3.873
• Publication Date: 2012-06-12T00:34:42Z
• Authors: Judith S. Hochman; Jean Boland; Lynn A. Sleeper; Mark Porway; Jeffrey Brinker; Jacques Col; Alice Jacobs; James Slater; David Miller; Hal Wasserman; Mark A. Menegus; J. David Talley; Sonja McKinlay; Timothy Sanborn; Thierry LeJemtel
• Keywords: 03 medical and health sciences; 0302 clinical medicine; 3. Good health

Background Cardiogenic shock remains the leading cause of death patients hospitalized with acute myocardial infarction (MI). This study was conducted to examine (1) current spectrum cardiogenic shock, (2) proportion who are potential candidates for a trial early revascularization, and (3) apparent impact revascularization on mortality. Methods Results Nineteen participating centers in United States Belgium prospectively registered all diagnosed shock. Two hundred fifty-one were registered. The mean age 67.5±11.7 years, 43% women. Acute mitral regurgitation or ventricular septal rupture 8%. Concurrent conditions contributing development noted 5%, 2% had isolated right Among remaining 214 patients, nonspecific findings ECG associated “nontransmural” MI seen 14%. median time diagnosis after 8 hours. overall in-hospital mortality 66%. Patients clinically selected undergo cardiac catheterization significantly younger lower than those not (51% versus 85%, P <.0001) even if they revascularized (58%). Mortality undergoing percutaneous transluminal coronary angioplasty (PTCA) 60% (n=55) 19% (n=16) artery bypass graft surgery (CABG). Sixty percent (n=150) judged eligible revascularization. Trial-eligible (65.4±11.0 70.6±11.9 <.001), an earlier onset (6.5 17.5 hours, =.003), (62% 73%, =.077) ineligible patients. Conclusions complicating heterogeneous group. Those tended have whether revascularized. Emergent PTCA CABG promising treatment modalities but biased case selection may confound data. Whether reduce which patient subgroups benefit most remain be determined randomized clinical trial.