Multicenter registry of angioplasty therapy of cardiogenic shock: initial and long-term survival

Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor.

This retrospective multicenter study reviews the role of acute percutaneous transluminal coronary angioplasty in the treatment of cardiogenic shock complicating acute myocardial infarction to determine whether early reperfusion affects in-hospital and long-term survival. From 1982 to 1985, 69 patients were treated with emergency angioplasty to attempt reperfusion of the infarct-related artery. Balloon angioplasty was unsuccessful in 20 patients (group 1) and successful in 49 patients (group 2). Initial clinical and angiographic findings in the groups with unsuccessful and successful angioplasty were similar with respect to age (60.5 +/- 2.3 versus 57 +/- 1.8 years), infarct location (65% versus 65% anterior) and gender (65% versus 67% male). Hemodynamic variables in the two groups, including systolic blood pressure (68 +/- 4.3 versus 73 +/- 1.6 mm Hg), left ventricular end-diastolic pressure (24.4 +/- 2.4 versus 27 +/- 1.0 mm Hg) and initial ejection fraction (28.5 +/- 4% versus 32 +/- 2%), were also similar. Twenty-nine patients received thrombolytic therapy with streptokinase; the overall rate of reperfusion was 34%. Group 1 patients had a short-term survival rate of 20%, compared with 69% in group 2 patients (p less than 0.0005). Thirty-eight patients survived the hospital period and were followed up for 24 to 54 months (mean 32.5 +/- 2.4). Five patients (all in group 2) died during follow-up. The long-term incidence rate of congestive heart failure was 19%, arrhythmia 21%, need for repeat angioplasty 17% and coronary artery bypass grafting 26%. Twenty-four month survival was significantly better in group 2 patients (54%) versus group 1 patients (11%, p = 0.003).(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				I. George and M. C. Oz Myocardial Revascularization after Acute Myocardial Infarction Card. Surg. Adult, January 1, 2008; 3(2008): 669 - 696. [Full Text]

				J. S. Hochman and R. Apolito The Calm After the Storm: Long-Term Survival After Cardiogenic Shock J. Am. Coll. Cardiol., October 30, 2007; 50(18): 1759 - 1760. [Full Text] [PDF]

				M. Singh, J. White, D. Hasdai, P. K. Hodgson, P. B. Berger, E. J. Topol, R. M. Califf, and D. R. Holmes Jr Long-Term Outcome and its Predictors Among Patients With ST-Segment Elevation Myocardial Infarction Complicated by Shock: Insights From the GUSTO-I Trial J. Am. Coll. Cardiol., October 30, 2007; 50(18): 1752 - 1758. [Abstract] [Full Text] [PDF]

				R. V. Jeger, S. M. Harkness, K. Ramanathan, C. E. Buller, M. E. Pfisterer, L. A. Sleeper, J. S. Hochman, and for the SHOCK Investigators Emergency revascularization in patients with cardiogenic shock on admission: a report from the SHOCK trial and registry Eur. Heart J., March 2, 2006; 27(6): 664 - 670. [Abstract] [Full Text] [PDF]

				S. C. Smith Jr, T. E. Feldman, J. W. Hirshfeld Jr, A. K. Jacobs, M. J. Kern, S. B. King III, D. A. Morrison, W. W. O'Neill, H. V. Schaff, P. L. Whitlow, et al. ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention) J. Am. Coll. Cardiol., January 3, 2006; 47(1): 216 - 235. [Full Text] [PDF]

				S. C. Smith Jr, T. E. Feldman, J. W. Hirshfeld Jr, A. K. Jacobs, M. J. Kern, S. B. King III, D. A. Morrison, W. W. O'Neill, H. V. Schaff, P. L. Whitlow, et al. ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention) Circulation, January 3, 2006; 113(1): 156 - 175. [Full Text] [PDF]

				U. Zeymer, A. Vogt, R. Zahn, M. A Weber, U. Tebbe, M. Gottwik, T. Bonzel, J. Senges, K.-L. Neuhaus, and for the Arbeitsgemeinschaft Leitende Kardiologisch Predictors of in-hospital mortality in 1333 patients with acute myocardial infarction complicated by cardiogenic shock treated with primary percutaneous coronary intervention (PCI): Results of the primary PCI registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte (ALKK) Eur. Heart J., February 2, 2004; 25(4): 322 - 328. [Abstract] [Full Text] [PDF]

				S. d. Graaf, M. Voskuil, and J. J. Piek Cardiogenic Shock Complicating an Acute Myocardial Infarction: Conservative Treatment Versus Revascularization Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2003; 7(1): 99 - 103. [PDF]

				D. C. Lee, W. Ting, and M. C. Oz Myocardial Revascularization after Acute Myocardial Infarction Card. Surg. Adult, January 1, 2003; 2(2003): 639 - 658. [Full Text]

				S. C. Wong, T. Sanborn, L. A. Sleeper, J. G. Webb, R. Pilchik, D. Hart, S. Mejnartowicz, T. A. Antonelli, R. Lange, J. K. French, et al. Angiographic findings and clinical correlates in patients with cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry J. Am. Coll. Cardiol., September 1, 2000; 36(3_Suppl_A): 1077 - 1083. [Abstract] [Full Text] [PDF]

				J. G. Webb, L. A. Sleeper, C. E. Buller, J. Boland, A. Palazzo, E. Buller, H. D. White, J. S. Hochman, and for the SHOCK Investigators Implications of the timing of onset of cardiogenic shock after acute myocardial infarction: a report from the SHOCK Trial Registry J. Am. Coll. Cardiol., September 1, 2000; 36(3_Suppl_A): 1084 - 1090. [Abstract] [Full Text] [PDF]

				A. K. Jacobs, J. K. French, J. Col, L. A. Sleeper, J. N. Slater, L. Carnendran, J. Boland, X. Jiang, T. LeJemtel, J. S. Hochman, et al. Cardiogenic shock with non-ST-segment elevation myocardial infarction: a report from the SHOCK Trial Registry J. Am. Coll. Cardiol., September 1, 2000; 36(3_Suppl_A): 1091 - 1096. [Abstract] [Full Text] [PDF]

				S G Williams, D J Wright, and L B Tan Management of cardiogenic shock complicating acute myocardial infarction: towards evidence based medical practice Heart, June 1, 2000; 83(6): 621 - 626. [Full Text]

				S. M. Hollenberg, C. J. Kavinsky, and J. E. Parrillo Cardiogenic Shock Ann Intern Med, July 6, 1999; 131(1): 47 - 59. [Abstract] [Full Text] [PDF]

				P. B. Berger, R. H. Tuttle, D. R. Holmes Jr, E. J. Topol, P. E. Aylward, J. H. Horgan, and R. M. Califf One-Year Survival Among Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock, and its Relation to Early Revascularization : Results From the GUSTO-I Trial Circulation, February 23, 1999; 99(7): 873 - 878. [Abstract] [Full Text] [PDF]

				D. W SMYTH and J. M ELLIOTT Treating coronaries, at home or away? Heart, October 1, 1997; 78(4): 329 - 330. [Full Text] [PDF]

				P. B. Berger, D. R. Holmes Jr, A. L. Stebbins, E. R. Bates, R. M. Califf, and E. J. Topol Impact of an Aggressive Invasive Catheterization and Revascularization Strategy on Mortality in Patients With Cardiogenic Shock in the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I) Trial : An Observational Study Circulation, July 1, 1997; 96(1): 122 - 127. [Abstract] [Full Text]

				T. Itoh, K. Fukami, S. Oriso, J. Umemura, J. Nakajima, H. Obonai, K. Hiramori, and K. Fukami Survival Following Cardiogenic Shock Caused by Acute Left Main Coronary Artery Total Occlusion: A Case Report and Review of the Literature Angiology, February 1, 1997; 48(2): 163 - 171. [Abstract] [PDF]

				COMMITTEE MEMBERS, J. F. WILLIAMS Jr, M. R. BRISTOW, M. B. FOWLER, G. S. FRANCIS, A. GARSON Jr, B. J. GERSH, D. F. HAMMER, M. A. HLATKY, C. V. LEIER, et al. Guidelines for the Evaluation and Management of Heart Failure : Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Evaluation and Management of Heart Failure) Circulation, November 1, 1995; 92(9): 2764 - 2784. [Full Text]

				J. S. Hochman, J. Boland, L. A. Sleeper, M. Porway, J. Brinker, J. Col, A. Jacobs, J. Slater, D. Miller, H. Wasserman, et al. Current Spectrum of Cardiogenic Shock and Effect of Early Revascularization on Mortality : Results of an International Registry Circulation, February 1, 1995; 91(3): 873 - 881. [Abstract] [Full Text]

				M. H. Eckman, J. B. Wong, D. N. Salem, and S. G. Pauker Direct Angioplasty for Acute Myocardial Infarction: A Review of Outcomes in Clinical Subsets Ann Intern Med, October 15, 1992; 117(8): 667 - 676. [Abstract] [PDF]

				ANGIOPLASTY MAY IMPROVE SURVIVAL IN CARDIOGENIC SHOCK Journal Watch (General), March 12, 1991; 1991(312): 4 - 4. [Full Text]