JACC
HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
QUICK SEARCH:   [advanced]


     

J Am Coll Cardiol, 2000; 35:136-143
© 2000 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Hasdai, D.
Right arrow Articles by Holmes, D. R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hasdai, D.
Right arrow Articles by Holmes, D. R., Jr.

CLINICAL STUDIES

Predictors of cardiogenic shock after thrombolytic therapy for acute myocardial infarction

David Hasdai, MD*, Robert M. Califf, MD, FACC{dagger}, Trevor D. Thompson, BS{dagger}, Judith S. Hochman, MD, FACC{ddagger}, E. Magnus Ohman, MD, FACC{dagger}, Matthias Pfisterer, MD, FACC§, Eric R. Bates, MD, FACC||, Alec Vahanian, MD, Paul W. Armstrong, MD, FACC#, Douglas A. Criger, MPH{dagger}, Eric J. Topol, MD, FACC** and David R. Holmes, Jr., MD, FACC{dagger}{dagger}

* Rabin Medical Center, Petah Tikva, Israel
{dagger} Duke University Medical Center, Durham, North Carolina, USA
{ddagger} St. Luke’s/Roosevelt Hospital Center, New York, New York, USA
§ University Hospital Basel, Basel, Switzerland
|| University of Michigan Medical Center, Ann Arbor, Michigan, USA
Hospital Tenon, Paris, France
# University of Alberta, Walter C. Mackenzie Health Center, Edmonton, Canada
** The Cleveland Clinic Foundation, Cleveland, Ohio, USA
{dagger}{dagger} Mayo Clinic, Rochester, Minnesota, USA

Manuscript received March 9, 1999; revised manuscript received July 2, 1999, accepted September 21, 1999.

Reprint requests and correspondence: Dr. David R. Holmes Jr, Division of Internal Medicine and Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905

OBJECTIVES

This study characterized clinical factors predictive of cardiogenic shock developing after thrombolytic therapy for acute myocardial infarction (AMI).

BACKGROUND

Cardiogenic shock remains a common and ominous complication of AMI. By identifying patients at risk of developing shock, preventive measures may be implemented to avert its development.

METHODS

We analyzed baseline variables associated with the development of shock after thrombolytic therapy in the Global Utilization of Streptikonase and Tissue-Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I) trial. Using a Cox proportional hazards model, we devised a scoring system predicting the risk of shock. This model was then validated in the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO-III) cohort.

RESULTS

Shock developed in 1,889 patients a median of 11.6 h after enrollment. The major factors associated with increased adjusted risk of shock were age ({chi}2 = 285, hazard ratio [95% confidence interval] 1.47 [1.40, 1.53]), systolic blood pressure ({chi}2 = 280), heart rate ({chi}2 = 225) and Killip class ({chi}2 = 161, hazard ratio 1.70 [1.52, 1.90] and 2.95 [2.39, 3.63] for Killip II versus I and Killip III versus I, respectively) upon presentation. Together, these four variables accounted for >85% of the predictive information. These findings were transformed into an algorithm with a validated concordance index of 0.758. Applied to the GUSTO-III cohort, the four variables accounted for >95% of the predictive information, and the validated concordance index was 0.796.

CONCLUSIONS

A scoring system accurately predicts the risk of shock after thrombolytic therapy for AMI based primarily on the patient’s age and physical examination on presentation.

Abbreviations and Acronyms
  AMI = acute myocardial infarction
  CI = confidence interval
  ECG = electrocardiographic
  GUSTO-I = Global Utilization of Streptokinase and Tissue-Plasminogen Activator for Occluded Coronary Arteries
  GUSTO-III = Global Use of Strategies to Open Occluded Coronary Arteries




This article has been cited by other articles:


Home page
 Arch Intern MedHome page
H. R. Reynolds, M. E. Farkouh, A. M. Lincoff, A. Hsu, E. Swahn, Z. P. Sadowski, J. A. White, E. J. Topol, J. S. Hochman, and for the GUSTO V Investigators
Impact of Female Sex on Death and Bleeding After Fibrinolytic Treatment of Myocardial Infarction in GUSTO V
Arch Intern Med, October 22, 2007; 167(19): 2054 - 2060.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
B. Verges, M. Zeller, G. Dentan, J.-C. Beer, Y. Laurent, L. Janin-Manificat, H. Makki, J. E. Wolf, Y. Cottin, and on behalf of the Observatoire des Infarctus de Cot
Impact of Fasting Glycemia on Short-Term Prognosis after Acute Myocardial Infarction
J. Clin. Endocrinol. Metab., June 1, 2007; 92(6): 2136 - 2140.
[Abstract] [Full Text] [PDF]

Home page
 QJMHome page
L. Lorgis, M. Zeller, G. Dentan, P. Sicard, M. Jolak, I. L'Huillier, M. Vincent-Martin, J.C. Beer, H. Makki, P. Gambert, et al.
High levels of N-terminal pro B-type natriuretic peptide are associated with ST resolution failure after reperfusion for acute myocardial infarction
QJM, April 1, 2007; 100(4): 211 - 216.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
R. H. Mehta, R. M. Califf, J. Garg, H. D. White, F. Van de Werf, P. W. Armstrong, K. S. Pieper, E. J. Topol, and C. B. Granger
The impact of anthropomorphic indices on clinical outcomes in patients with acute ST-elevation myocardial infarction
Eur. Heart J., February 2, 2007; 28(4): 415 - 424.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
B. Verges, M. Zeller, J. Desgres, G. Dentan, Y. Laurent, L. Janin-Manificat, I. L'Huillier, G. Rioufol, J.-C. Beer, H. Makki, et al.
High plasma N-terminal pro-brain natriuretic peptide level found in diabetic patients after myocardial infarction is associated with an increased risk of in-hospital mortality and cardiogenic shock
Eur. Heart J., September 1, 2005; 26(17): 1734 - 1741.
[Abstract] [Full Text] [PDF]

Home page
 Arch Intern MedHome page
M. Zeller, P. G. Steg, J. Ravisy, Y. Laurent, L. Janin-Manificat, I. L'Huillier, J.-C. Beer, A. Oudot, G. Rioufol, H. Makki, et al.
Prevalence and Impact of Metabolic Syndrome on Hospital Outcomes in Acute Myocardial Infarction
Arch Intern Med, May 23, 2005; 165(10): 1192 - 1198.
[Abstract] [Full Text] [PDF]

Home page
 ANGIOLOGYHome page
K. P. Bouki, G. Pavlakis, and E. Papasteriadis
Management of Cardiogenic Shock Due to Acute Coronary Syndromes
Angiology, March 1, 2005; 56(2): 123 - 130.
[Abstract] [PDF]

Home page
 CirculationHome page
A. J. Lansky, J. S. Hochman, P. A. Ward, G. S. Mintz, R. Fabunmi, P. B. Berger, G. New, C. L. Grines, C. G. Pietras, M. J. Kern, et al.
Percutaneous Coronary Intervention and Adjunctive Pharmacotherapy in Women: A Statement for Healthcare Professionals From the American Heart Association
Circulation, February 22, 2005; 111(7): 940 - 953.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
G Montalescot, H R Andersen, D Antoniucci, A Betriu, M J de Boer, L Grip, F J Neumann, and M T Rothman
Recommendations on percutaneous coronary intervention for the reperfusion of acute ST elevation myocardial infarction
Heart, June 1, 2004; 90(6): e37 - e37.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
M. H. Picard, R. Davidoff, L. A. Sleeper, L. A. Mendes, C. R. Thompson, V. Dzavik, R. Steingart, K. Gin, H. D. White, J. S. Hochman, et al.
Echocardiographic Predictors of Survival and Response to Early Revascularization in Cardiogenic Shock
Circulation, January 21, 2003; 107(2): 279 - 284.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
V. Menon and J. S Hochman
MANAGEMENT OF CARDIOGENIC SHOCK COMPLICATING ACUTE MYOCARDIAL INFARCTION
Heart, December 1, 2002; 88(5): 531 - 537.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
H.D. White
Cardiogenic shock: a more aggressive approach is now warranted
Eur. Heart J., December 1, 2000; 21(23): 1897 - 1901.
[PDF]

Home page
 J Am Coll CardiolHome page
D. Hasdai, R. A. Harrington, J. S. Hochman, R. M. Califf, A. Battler, J. W. Box, M. L. Simoons, J. Deckers, E. J. Topol, and D. R. Holmes Jr.
Platelet glycoprotein IIb/IIIa blockade and outcome of cardiogenic shock complicating acute coronary syndromes without persistent ST-segment elevation
J. Am. Coll. Cardiol., September 1, 2000; 36(3): 685 - 692.
[Abstract] [Full Text] [PDF]


HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
Copyright © 2000 by the American College of Cardiology Foundation.