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 Sanborn, T. A. Search for Related Content PubMed PubMed Citation Articles by Sanborn, T. A.

CLINICAL RESEARCH: CARDIOGENIC SHOCK

Correlates of one-year survival inpatients with cardiogenic shock complicating acute myocardial infarction

Angiographic findings from the SHOCK trial

Timothy A. Sanborn, MD^*,*, Lynn A. Sleeper, ScD, John G. Webb, MD, John K. French, MBChB, PhD, Geoffrey Bergman, MB, BS^||, Manish Parikh, MD^||, S. Chiu Wong, MD^||, Jean Boland, MD^¶, Matthias Pfisterer, MD^**, James N. Slater, MD, Samin Sharma, MD, Judith S. Hochman, MD SHOCK Investigators

^* Evanston Northwestern Healthcare, Evanston, Illinois, USA
New England Research Institutes, Inc., Watertown, Massachusetts, USA
St. Paul's Hospital, Vancouver, British Columbia, Canada
Green Lane Hospital, Auckland, New Zealand
^|| New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA
^¶ CHR Citadelle, Liège, Belgium
^** University Hospital, Basel, Switzerland
St. Luke's-Roosevelt Hospital Center and Columbia University, New York, New York, USA
Mount Sinai Medical Center, New York, New York, USA
New York University School of Medicine, New York, New York, USA

Manuscript received December 18, 2002; revised manuscript received April 23, 2003, accepted April 30, 2003.

^* Reprint requests and correspondence: Dr. Timothy A. Sanborn, Evanston Northwestern Healthcare, Division of Cardiology, Burch 300, 2650 Ridge Avenue, Evanston, Illinois 60201, USA.
tsanborn{at}enh.org

OBJECTIVES: The goal of this study was to describe the core laboratory angiographic findings of "SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK" (SHOCK) trial participants and to determine the relationship of angiographic parameters to one-year survival.

BACKGROUND: In the SHOCK trial, emergency revascularization improved one-year survival of patients with cardiogenic shock compared with initial medical stabilization including thrombolysis and intraaortic balloon counterpulsation.

METHODS: Coronary angiography was performed by protocol in 147 of 152 (97%) patients in the emergency revascularization (ERV) group and by clinical selection in 100 of 150 (67%) patients in the initial medical stabilization (IMS) group. Of the other 50 IMS patients, 45 of 50 (90%) died rapidly and did not undergo angiography.

RESULTS: Left ventricular ejection fraction was correlated with one-year survival in both treatment groups (p < 0.001). In the IMS group, the hazard ratio for death was 2.59 (95% confidence interval 1.47 to 4.58, p = 0.001) per diseased vessel (0/1 vs. 2 vs. 3). In the ERV group, the hazard ratio for death per diseased vessel was 1.11 (95% confidence interval 0.79 to 1.56, p = 0.559). Multivariate analysis of the angiography cohort (without regard for left ventriculogram measurements) identified initial Thrombolysis in Myocardial Infarction flow grade (p = 0.032), number of diseased vessels (for IMS patients only, p = 0.024), and culprit vessel (p = 0.004) as independent correlates of one-year survival, even after adjustment for key clinical factors. In the smaller cohort with left ventricular ejection fraction measured (n = 97), ejection fraction and culprit vessel remained independently correlated with survival.

CONCLUSIONS: For patients in cardiogenic shock, left ventricular function and culprit vessel were independent correlates of one-year survival.

Abbreviations and Acronyms   CABG = coronary artery bypass grafting   ERV = emergency revascularization   IMS = initial medical stabilization   LAD = left anterior descending artery   LCX = left circumflex artery   LM = left main coronary artery   LVEF = left ventricular ejection fraction   MR = mitral regurgitation   PCI = percutaneous coronary intervention   RCA = right coronary artery   SHOCK = "SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK" trial   SVG = saphenous vein graft   TIMI = Thrombolysis In Myocardial Infarction

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]

				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]