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CLINICAL STUDY

Diabetes mellitus in cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry

Daniel M. Shindler, MD, FACC^*, Sebastian T. Palmeri, MD, FACC^*, Tracy A. Antonelli, MPH, Lynn A. Sleeper, ScD, Jean Boland, MD, Thomas P. Cocke, MD, FACC, Judith S. Hochman, MD, FACC^|| for the SHOCK Investigators

^* UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
New England Research Institutes, Watertown, Massachusetts, USA
Centre Hospitalier de la Citadelle, Liège, Belgium
Mt. Sinai Medical Center, New York, New York, USA
^|| St. Luke’s–Roosevelt Hospital, New York, New York, USA

Manuscript received February 16, 2000; revised manuscript received June 2, 2000, accepted June 7, 2000.

Reprint requests and correspondence: Dr. Daniel M. Shindler, 1 Gloucester Court, East Brunswick, New Jersey 08816
shindler{at}umdnj.edu

OBJECTIVES

We sought to examine the role of diabetes mellitus in cardiogenic shock (CS) complicating acute myocardial infarction (AMI) in the SHOCK Trial Registry.

BACKGROUND

The characteristics, outcomes and optimal treatment of diabetic patients with CS complicating AMI have not been well described.

METHODS

Baseline characteristics, clinical and hemodynamic measures, treatment variables, shock etiologies and comorbid conditions were compared for 379 diabetic and 784 nondiabetic patients. Logistic regression was used to examine the association between diabetes and in-hospital mortality, after adjustment for baseline differences.

RESULTS

Diabetics were less likely than nondiabetics to undergo thrombolysis (28% vs. 37%; p = 0.002) or attempted revascularization (40% vs. 49%; p = 0.008). The survival benefit for diabetics selected for percutaneous or surgical revascularization (55% vs. 19% without revascularization) was similar to that for nondiabetics (59% vs. 25%). Overall unadjusted in-hospital mortality was significantly higher for diabetics (67% vs. 58%; p = 0.007), but diabetes was only a borderline predictor of mortality after adjustment for baseline and treatment differences (odds ratio for death, 1.36; 95% confidence interval, 1.00 to 1.84; p = 0.051).

CONCLUSIONS

Diabetics with CS complicating AMI have a higher-risk profile at baseline, but after adjustment, diabetics have an in-hospital survival rate that is only marginally lower than that of nondiabetics. Diabetics who undergo revascularization derive a survival benefit similar to that of nondiabetics.

Abbreviations and Acronyms   AMI = acute myocardial infarction   BARI = Bypass Angioplasty Revascularization Investigation   BUN = blood urea nitrogen   CK(-MB) = creatine kinase (-MB)   CS = cardiogenic shock   GUSTO-I = Global Utilization of Streptokinase and TPA (alteplase) for Occluded coronary arteries (trial)   LV = left ventricular, left ventricle   MR = mitral regurgitation   RV = right ventricular   SHOCK = SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK? (trial)

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