HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Jacobs, A. K. Articles by Hochman, J. S. Search for Related Content PubMed PubMed Citation Articles by Jacobs, A. K. Articles by Hochman, J. S.

CLINICAL STUDY: ACUTE CORONARY SYNDROMES/INFARCTION

Cardiogenic shock caused by right ventricular infarction

A report from the SHOCK registry

Alice K. Jacobs, MD, FACC^*,*, Jane A. Leopold, MD, FACC^*, Eric Bates, MD, FACC, Lisa A. Mendes, MD, FACC^*, Lynn A. Sleeper, ScD, Harvey White, DSc, Ravin Davidoff, MB, BCh^*, Jean Boland, MD^||, Sharada Modur, MS, Robert Forman, MD, FACC^¶ and Judith S. Hochman, MD, FACC^#

^* Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
University of Michigan Medical Center, Ann Arbor, Michigan, USA
New England Research Institutes, Watertown, Massachusetts, USA
Green Lane Hospital, Auckland, New Zealand
^|| Centre Hospitalier Regional Citadelle, Liege, Belgium
^¶ Weiler Hospital of the Albert Einstein College of Medicine, Bronx, New York, USA
^# St. Luke’s-Roosevelt Hospital Center, New York, New York, USA

Manuscript received February 4, 2002; revised manuscript received October 17, 2002, accepted October 31, 2002.

^* Reprint requests and correspondence: Dr. Alice K. Jacobs, Boston Medical Center, Section of Cardiology, 88 East Newton Street, Boston, Massachusetts 02118, USA.
alice.jacobs{at}bmc.org

OBJECTIVES: The purpose of this study was to determine the characteristics and outcomes of patients with acute myocardial infarction (MI) complicated by cardiogenic shock due to predominant right ventricular (RV) infarction.

BACKGROUND: Although RV infarction has been shown to have favorable long-term outcomes, the influence of RV infarction on mortality in cardiogenic shock is unknown.

METHODS: We evaluated 933 patients in cardiogenic shock due to predominant RV (n = 49) or left ventricular (LV) failure (n = 884) in the SHould we emergently revascularize Occluded coronaries for Cardiogenic shocK? (SHOCK) trial registry.

RESULTS: Patients with predominant RV shock were younger, with a lower prevalence of previous MI (25.5 vs. 40.1%, p = 0.047), anterior MI, and multivessel disease (34.8 vs. 77.8%, p < 0.001) and a shorter median time between the index MI and the diagnosis of shock (2.9 vs. 6.2 h, p = 0.003) in comparison to patients with LV shock. In-hospital mortality was 53.1% versus 60.8% (p = 0.296) for patients with predominant RV and LV shock, respectively, and the influence of revascularization on mortality was not different between groups. Multivariate analysis revealed that RV shock was not an independent predictor of lower in-hospital mortality (odds ratio 1.07, 95% confidence interval 0.54 to 2.13).

CONCLUSIONS: Despite the younger age, lower rate of anterior MI, and higher prevalence of single-vessel coronary disease of RV compared with LV shock patients, and their similar benefit from revascularization, mortality is unexpectedly high in patients with predominant RV shock and similar to patients with LV shock.

Abbreviations and Acronyms   CK   creatine kinase   ECG   electrocardiographic   LAD   left anterior descending coronary artery   LV   left ventricular   MI   myocardial infarction   RCA   right coronary artery   RV   right ventricular   SHOCK   SHould we emergently revascularize Occluded coronaries for Cardiogenic shocK?

This article has been cited by other articles:

				H. R. Reynolds and J. S. Hochman Cardiogenic Shock: Current Concepts and Improving Outcomes Circulation, February 5, 2008; 117(5): 686 - 697. [Full Text] [PDF]

				A. Chockalingam, G. Gnanavelu, T. Subramaniam, S. Dorairajan, and V. Chockalingam Right Ventricular Myocardial Infarction: Presentation and Acute Outcomes Angiology, July 1, 2005; 56(4): 371 - 376. [Abstract] [PDF]

				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]

				T. Carter and K. Ellis Right-ventricular infarction. Crit. Care Nurse, April 1, 2005; 25(2): 52 - 2. [Full Text] [PDF]

				I. Inglessis, J. T. Shin, J. J. Lepore, I. F. Palacios, W. M. Zapol, K. D. Bloch, and M. J. Semigran Hemodynamic effects of inhaled nitric oxide in right ventricular myocardial infarction and cardiogenic shock J. Am. Coll. Cardiol., August 18, 2004; 44(4): 793 - 798. [Abstract] [Full Text] [PDF]

				J. S. Hochman Cardiogenic Shock Complicating Acute Myocardial Infarction: Expanding the Paradigm Circulation, June 24, 2003; 107(24): 2998 - 3002. [Full Text] [PDF]

				J. A. Goldstein Right versus left ventricular shock: A tale of two ventricles J. Am. Coll. Cardiol., April 16, 2003; 41(8): 1280 - 1282. [Full Text] [PDF]