Advertisement






Click here for more guidelines.
CME Topic Collections Past Issues Search Current Issue Home
     

J Am Coll Cardiol, 2000; 36:1117-1122
© 2000 by the American College of Cardiology Foundation
This Article
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 Web of Science
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 Web of Science (19)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Slater, J.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Slater, J.

CLINICAL STUDY

Cardiogenic shock due to cardiac free-wall rupture or tamponade after acute myocardial infarction: a report from the SHOCK Trial Registry

James Slater, MD, FACC*, Robert J. Brown, MD*, Tracy A. Antonelli, MPH{dagger}, Venu Menon, MD, FACC*, Jean Boland, MD{ddagger}, Jacques Col, MD§, Vladimir Dzavik, MD||, Mark Greenberg, MD, FACC, Mark Menegus, MD, FACC, Cliff Connery, MD*, Judith S. Hochman, MD, FACC* for the SHOCK Investigators

* St. Luke’s-Roosevelt Medical Center, New York, New York, USA
{dagger} New England Research Institutes, Watertown, Massachusetts, USA
{ddagger} Hopital de la Citadelle, Liège, Belgium
§ Clinique Universitaire St. Luc, Brussels, Belgium
|| University of Alberta Hospital, Edmonton, Alberta, Canada
Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, New York, USA

Manuscript received February 16, 2000; revised manuscript received June 7, 2000, accepted June 13, 2000.

Reprint requests and correspondence: Dr. James Slater, Division of Cardiology, St. Luke’s/Roosevelt Hospital, 1111 Amsterdam Ave., New York, NY 10025
jslater{at}slrhc.org

OBJECTIVES

We sought to compare the characteristics and outcomes of patients with acute myocardial infarction (MI) and cardiogenic shock (CS) caused by rupture of the ventricular free wall or tamponade versus shock from other causes.

BACKGROUND

Free-wall rupture is a recognized cause of mortality in patients with acute MI. Some of these patients present subacutely, which provides an opportunity for intervention. Recognition of factors that distinguish them from the overall shock cohort would be beneficial.

METHODS

The international SHOCK Trial Registry enrolled patients concurrently with the randomized SHOCK Trial. Thirty-six centers consecutively enrolled all patients with suspected CS after MI, regardless of trial eligibility.

RESULTS

Of the 1,048 patients studied, 28 (2.7%) had free-wall rupture or tamponade. These patients had less pulmonary edema, less diabetes, less prior MI, and less prior congestive heart failure (all p < 0.05). They more often had new Q waves in two or more leads (51.9% vs. 31.5%, p < 0.04), but MI location and time to shock onset after MI did not differ. Of patients with rupture or tamponade, 75% had pericardial effusions. No hemodynamic characteristics identified patients with rupture/tamponade. Most patients with rupture/tamponade had surgery and/or pericardiocentesis (27/28); their in-hospital survival rate was identical to that of the group overall (39.3%). Women and older patients with rupture/tamponade tended to survive intervention less often.

CONCLUSIONS

Free-wall rupture and tamponade may present as CS after MI, and survival after intervention is similar to that of the overall shock cohort. All patients with CS after MI should have echocardiography in order to detect subacute rupture or tamponade and initiate appropriate interventions.

Abbreviations and Acronyms
  BP = blood pressure
  CS = cardiogenic shock
  LV = left ventricular, left ventricle
  MI = myocardial infarction
  MR = mitral regurgitation
  RV = right ventricular, right ventricle
  SHOCK = SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK? (trial)




This article has been cited by other articles:


Home page
Eur J EchocardiogrHome page
M. Dencker, G. Tasevska, D. Grubb, M. Stagmo, and R. Gustafsson
Unexpected rupture of the left ventricular free wall in the echo-lab
Eur J Echocardiogr, January 1, 2008; 9(1): 92 - 94.
[Abstract] [Full Text] [PDF]


Home page
RadioGraphicsHome page
C. S. Restrepo, D. F. Lemos, J. A. Lemos, E. Velasquez, L. Diethelm, T. A. Ovella, S. Martinez, J. Carrillo, R. Moncada, and J. S. Klein
Imaging Findings in Cardiac Tamponade with Emphasis on CT
RadioGraphics, November 1, 2007; 27(6): 1595 - 1610.
[Abstract] [Full Text] [PDF]


Home page
ANGIOLOGYHome page
G. Weissman, C. C. Kwon, R. K. Shaw, and J. F. Setaro
Free-Wall Rupture of the Myocardium Following Infarction: A Changing Clinical Portrait in the Reperfusion Era: A Case Report
Angiology, October 1, 2006; 57(5): 636 - 642.
[Abstract] [PDF]


Home page
Eur Heart JHome page
H. Bueno, M. Martinez-Selles, E. Perez-David, and R. Lopez-Palop
Effect of thrombolytic therapy on the risk of cardiac rupture and mortality in older patients with first acute myocardial infarction
Eur. Heart J., September 1, 2005; 26(17): 1705 - 1711.
[Abstract] [Full Text] [PDF]


Home page
J Intensive Care MedHome page
C. S. Duvernoy and E. R. Bates
Management of Cardiogenic Shock Attributable to Acute Myocardial Infarction in the Reperfusion Era
J Intensive Care Med, July 1, 2005; 20(4): 188 - 198.
[Abstract] [PDF]


Home page
Eur J EchocardiogrHome page
J. Pindado, P. Marcos-Alberca, M. Rey, R. Rabago, C. de Diego, B. Ibanez, M. Cordoba, and J. Farre
Incomplete myocardial rupture after coronary embolism of an isolated single coronary artery
Eur J Echocardiogr, January 1, 2005; 6(1): 72 - 74.
[Abstract] [Full Text] [PDF]


Home page
ChestHome page
H.-K. Yip, C.-Y. Fang, K.-T. Tsai, H.-W. Chang, K.-H. Yeh, M. Fu, and C.-J. Wu
The Potential Impact of Primary Percutaneous Coronary Intervention on Ventricular Septal Rupture Complicating Acute Myocardial Infarction
Chest, May 1, 2004; 125(5): 1622 - 1628.
[Abstract] [Full Text] [PDF]


Home page
ChestHome page
H.-K. Yip, C.-J. Wu, H.-W. Chang, C.-P. Wang, C.-I Cheng, S. Chua, and M.-C. Chen
Cardiac Rupture Complicating Acute Myocardial Infarction in the Direct Percutaneous Coronary Intervention Reperfusion Era
Chest, August 1, 2003; 124(2): 565 - 571.
[Abstract] [Full Text] [PDF]



 
  CME Topic Collections Past Issues Search Current Issue Home

Advertisement