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CLINICAL RESEARCH: MYOCARDIAL INFARCTION

Functional Status and Quality of Life After Emergency Revascularization for Cardiogenic Shock Complicating Acute Myocardial Infarction

Lynn A. Sleeper, ScD^_*,_*, Krishnan Ramanathan, MD, Michael H. Picard, MD, Thierry H. LeJemtel, MD, Harvey D. White, MD^||, Vladimir Dzavik, MD^¶, Deborah Tormey, RN^#, Nancy E. Avis, PhD^_**, Judith S. Hochman, MD for the SHOCK Investigators

^_* New England Research Institutes, Watertown, Massachusetts
New York University School of Medicine, New York, New York
Massachusetts General Hospital, Boston, Massachusetts
Division of Cardiology, Albert Einstein College of Medicine, Bronx, New York
^|| Department of Cardiology, Auckland City Hospital, Auckland, New Zealand
^¶ Toronto General Hospital, Toronto, Ontario, Canada
^# St. Luke’s/Roosevelt Hospital Center, New York, New York
^_** Wake Forest University Health Sciences, Winston-Salem, North Carolina.

Manuscript received November 4, 2004; revised manuscript received January 7, 2005, accepted January 11, 2005.

^_* Reprint requests and correspondence: Dr. Lynn A. Sleeper, New England Research Institutes, 9 Galen Street, Watertown, Massachusetts 02472. (Email: lsleeper{at}neriscience.com).

OBJECTIVES: Our goal was to describe the functional status of cardiogenic shock survivors, identify the correlates of cardiogenic shock, and compare global quality of life and functional status of patients randomly assigned to treatment with emergency revascularization (ERV) versus initial medical stabilization (IMS).

BACKGROUND: Historically, the hospital survival rate of patients with cardiogenic shock complicating acute myocardial infarction (MI) has been very low. Shock survivors are salvaged from a critically ill state, and their later functional status is not well documented. The SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK (SHOCK) trial showed significantly improved one-year survival after ERV compared with IMS.

METHODS: The SHOCK trial survivors completed interviews at 2 weeks after discharge and at 6 and 12 months after MI. Functional status assessment included the Multidimensional Index of Life Quality and New York Heart Association (NYHA) congestive heart failure functional class.

RESULTS: Eighty-seven percent of one-year survivors of the SHOCK trial were in NYHA functional class I or II. Between two weeks after discharge and one year after MI, improvement was similar in the two treatment groups (18% overall), but fewer patients remained stable (44% vs. 71%), and more patients worsened or died (34% vs. 15%) in the IMS group compared with those assigned to ERV. Assignment to ERV was the only independent predictor of outcome at one year.

CONCLUSIONS: Although one-year mortality after ERV is still high (54%), most survivors have good functional status. The ERV patients have a lower rate of deterioration than IMS patients. The level of recovery for shock patients undergoing ERV is similar to that of historical controls not in cardiogenic shock undergoing elective revascularization.

Abbreviations and Acronyms   ERV = emergency revascularization   IMS = initial medical stabilization   MI = myocardial infarction   MILQ = Multidimensional Index of Life Quality   NYHA = New York Heart Association   SHOCK = SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK

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