CLINICAL RESEARCH: CARDIOGENIC SHOCK
Percutaneous coronary intervention for cardiogenic shock in the SHOCK trial
John G. Webb, MD, FACC*,*,
April M. Lowe, MS ,
Timothy A. Sanborn, MD, FACC ,
Harvey D. White, DSc ,
Lynn A. Sleeper, ScD,
Ronald G. Carere, MD, FACC*,
Christopher E. Buller, MD, FACC||,
S. Chiu Wong, MD, FACC¶,
Jean Boland, MD#,
Vlad Dzavik, MD**,
Mark Porway, MD, FACC,
Gordon Pate, MB*,
Geoffrey Bergman, MD, FACC¶,
Judith S. Hochman, MD, FACC for the SHOCK Investigators
* St. Paul's Hospital, Vancouver, Canada
New England Research Institutes, Watertown, Massachusetts, USA
Evanston Northwestern Healthcare, Evanston, Illinois, USA
Green Lane Hospital, Auckland, New Zealand
|| Vancouver General Hospital, Vancouver, Canada
¶ New York Presbyterian, New York, New York, USA
# CHR Citadelle, Liege, Belgium
** Toronto General Hospital, Toronto, Canada
Baystate Medical Center, Springfield, Massachusetts, USA
Division of Cardiology, New York University School of Medicine, New York, New York, USA
Manuscript received January 18, 2003;
revised manuscript received March 20, 2003,
accepted March 27, 2003.
* Reprint requests and correspondence: Dr. John G. Webb, Director, Cardiac Catheterization and Interventional Cardiology, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6.
webb{at}providencehealth.bc.ca
OBJECTIVES: We examined the clinical, angiographic, and procedural characteristics determining survival after percutaneous coronary intervention (PCI) for cardiogenic shock.
BACKGROUND: The SHOCK (SHould we emergently revascularize Occluded coronaries for Cardiogenic shocK?) trial prospectively enrolled patients with shock complicating acute myocardial infarction (MI). Patients were randomized to a strategy of early revascularization or initial medical stabilization.
METHODS: Patients randomized to early revascularization underwent PCI or bypass surgery on the basis of predefined clinical criteria. Patients randomized to early revascularization who underwent PCI and had angiographic films available for analysis are the subject of this report (n = 82).
RESULTS: The median time from MI to PCI was 11 h. The majority of patients had occluded culprit arteries (Thrombolysis In Myocardial Infarction [TIMI] grade 0 or 1 flow in 62%) and multivessel disease (81%). One-year mortality in PCI patients was 50%. Mortality was 39% if PCI was successful but 85% if unsuccessful (p < 0.001). Mortality was 38% if TIMI flow grade 3 was achieved, 55% with TIMI grade 2 flow, and 100% with TIMI grade 0 or 1 flow (p < 0.001). Mortality was 67% if severe mitral regurgitation was documented. Independent correlates of mortality were as follows: increasing age (p < 0.001), lower systolic blood pressure (p = 0.009), increasing time from randomization to PCI (p = 0.019), lower post-PCI TIMI flow (0/1 vs. 2/3) (p < 0.001), and multivessel PCI (p = 0.040).
CONCLUSIONS: Restoration of coronary blood flow is a major predictor of survival in cardiogenic shock. Benefit appears to extend beyond the generally accepted 12-h post-infarction window. Surgery should be considered in shock patients with severe mitral insufficiency or multivessel disease not amenable to relatively complete percutaneous revascularization.
|
Abbreviations and Acronyms
| | GP | = glycoprotein | | MI | = myocardial infarction | | PCI | = percutaneous coronary intervention | | SHOCK | = SHould we emergently revascularize Occluded coronaries for Cardiogenic shocK | | TIMI | = Thrombolysis In Myocardial Infarction |
|
This article has been cited by other articles:
|
|
|
|
 
F Saia, C Marrozzini, P Ortolani, T Palmerini, P Guastaroba, P Cortesi, P C Pavesi, G Gordini, L G Pancaldi, N Taglieri, et al.
Optimisation of therapeutic strategies for ST-segment elevation acute myocardial infarction: the impact of a territorial network on reperfusion therapy and mortality
Heart,
March 1, 2009;
95(5):
370 - 376.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. S. Lim, O. Farouque, N. Andrianopoulos, B. P. Yan, C. C.S. Lim, A. L. Brennan, C. M. Reid, M. Freeman, K. Charter, A. Black, et al.
Survival of Elderly Patients Undergoing Percutaneous Coronary Intervention for Acute Myocardial Infarction Complicated by Cardiogenic Shock
J. Am. Coll. Cardiol. Intv.,
February 1, 2009;
2(2):
146 - 152.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. S. Lee, C.-H. Tseng, C. M. Barker, V. Menon, D. Steckman, R. Shemin, and J. S. Hochman
Outcome After Surgery and Percutaneous Intervention for Cardiogenic Shock and Left Main Disease
Ann. Thorac. Surg.,
July 1, 2008;
86(1):
29 - 34.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
I. George and M. C. Oz
Myocardial Revascularization after Acute Myocardial Infarction
Card. Surg. Adult,
January 1, 2008;
3(2008):
669 - 696.
[Full Text]
|
|
|
|
|
|
|
S. Carstensen, G. C.I. Nelson, P. S. Hansen, L. Macken, S. Irons, M. Flynn, P. Kovoor, S. Y. Soo Hoo, M. R. Ward, and H. H. Rasmussen
Field triage to primary angioplasty combined with emergency department bypass reduces treatment delays and is associated with improved outcome
Eur. Heart J.,
October 1, 2007;
28(19):
2313 - 2319.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Sorajja, B. J. Gersh, D. A. Cox, M. G. McLaughlin, P. Zimetbaum, C. Costantini, T. Stuckey, J. E. Tcheng, R. Mehran, A. J. Lansky, et al.
Impact of multivessel disease on reperfusion success and clinical outcomes in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction
Eur. Heart J.,
July 2, 2007;
28(14):
1709 - 1716.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K D Dawkins, T Gershlick, M de Belder, A Chauhan, G Venn, P Schofield, D Smith, J Watkins, H H Gray, and Joint Working Group on Percutaneous Coronary Inter
Percutaneous coronary intervention: recommendations for good practice and training
Heart,
December 1, 2005;
91(suppl_6):
vi1 - vi27.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. D. White, S. F. Assmann, T. A. Sanborn, A. K. Jacobs, J. G. Webb, L. A. Sleeper, C.-K. Wong, J. T. Stewart, P. E.G. Aylward, S.-C. Wong, et al.
Comparison of Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting After Acute Myocardial Infarction Complicated by Cardiogenic Shock: Results From the Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) Trial
Circulation,
September 27, 2005;
112(13):
1992 - 2001.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. C. Dang, V. K. Topkara, M. Leacche, R. John, J. G. Byrne, and Y. Naka
Left ventricular assist device implantation after acute anterior wall myocardial infarction and cardiogenic shock: A two-center study
J. Thorac. Cardiovasc. Surg.,
September 1, 2005;
130(3):
693 - 698.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Authors/Task Force Members, S. Silber, P. Albertsson, F. F. Aviles, P. G. Camici, A. Colombo, C. Hamm, E. Jorgensen, J. Marco, J.-E. Nordrehaug, et al.
Guidelines for Percutaneous Coronary Interventions: The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology
Eur. Heart J.,
April 2, 2005;
26(8):
804 - 847.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A G C Sutton, P Finn, J A Hall, A A Harcombe, R A Wright, and M A de Belder
Predictors of outcome after percutaneous treatment for cardiogenic shock
Heart,
March 1, 2005;
91(3):
339 - 344.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
