CLINICAL STUDY
Cardiogenic shock complicating acute myocardial infarction—etiologies, management and outcome: a report from the SHOCK Trial Registry
Judith S. Hochman, MD, FACC*,
Christopher E. Buller, MD, FACC ,
Lynn A. Sleeper, ScD ,
Jean Boland, MD ,
Vladimir Dzavik, MD||,
Timothy A. Sanborn, MD, FACC¶,
Emilie Godfrey, MS, RD*,
Harvey D. White, DSc, FACC,
John Lim, BA,
Thierry LeJemtel, MD** for the SHOCK Investigators
* St. Luke’s–Roosevelt Hospital Center and Columbia University, New York, New York, USA
Vancouver Hospital & Science Center, Laurel Cardiology, Vancouver, British Columbia, Canada
New England Research Institutes, Watertown, Massachusetts, USA
CHR Citadelle, Department of Cardiology, Liège, Belgium
|| University of Alberta, Div. of Cardiology, Edmonton, Canada
¶ New York Cornell Medical Center, New York, New York, USA
Green Lane Hospital, Auckland, New Zealand
** Albert Einstein Medical Center (College of Medicine), New York, New York, USA
Manuscript received February 16, 2000;
accepted March 17, 2000.
Request reprints and correspondence: Dr. Judith S. Hochman, St. Luke’s Roosevelt Hospital Center, 1111 Amsterdam Avenue, New York, New York 10025
OBJECTIVES
This SHOCK Study report seeks to provide an overview of patients with cardiogenic shock (CS) complicating acute myocardial infarction (MI) and the outcome with various treatments. The outcome of patients undergoing revascularization in the SHOCK Trial Registry and SHOCK Trial are compared.
BACKGROUND
Cardiogenic shock is the leading cause of death in patients hospitalized for acute MI. The randomized SHOCK Trial reported improved six-month survival with early revascularization.
METHODS
Patients with CS complicating acute MI who were not enrolled in the concurrent randomized trial were registered. Patient characteristics were recorded as were procedures and vital status at hospital discharge.
RESULTS
Between April 1993 and August 1997, 1,190 patients with CS were registered and 232 were randomized in the SHOCK Trial. Predominant left ventricular failure (78.5%) was most common, with isolated right ventricular shock in 2.8%, severe mitral regurgitation in 6.9%, ventricular septal rupture in 3.9% and tamponade in 1.4%. In-hospital Registry mortality was 60%, with ventricular septal rupture associated with a significantly higher mortality (87.3%) than all other categories (p < 0.01). The risk profile and mortality were lower for Registry patients who were managed with thrombolytic therapy and/or intra-aortic balloon counterpulsation, coronary angiography, angioplasty and/or coronary artery bypass surgery. After adjusting for these differences, the extent to which survival was improved with early revascularization was similar to that observed in the randomized SHOCK Trial.
CONCLUSIONS
In this prospective Registry the etiology of CS was a mechanical complication in 12%. The similarity of the beneficial treatment effect in patients undergoing early revascularization in the SHOCK Trial Registry and SHOCK Trial provides strong support for the generalizability of the SHOCK Trial results.
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Abbreviations and Acronyms
| | CK | = creatine kinase | | CS | = cardiogenic shock | | LBBB | = left bundle branch block | | LV | = left ventricular, left ventricle | | MI | = myocardial infarction | | MR | = mitral regurgitation | | PCWP | = pulmonary capillary wedge pressure | | RV | = right ventricular, right ventricle | | SHOCK | = SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK? | | VSR | = ventricular septal rupture |
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