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) All Versions of this Article: j.jacc.2007.04.101v1 50/18/1752    most recent 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 ISI Web of Science Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (5) Citing Articles via Google Scholar Google Scholar Articles by Singh, M. Articles by Holmes, D. R. Search for Related Content PubMed Articles by Singh, M. Articles by Holmes, D. R., Jr Related Collections Related Article

CLINICAL RESEARCH: MYOCARDIAL INFARCTION

Long-Term Outcome and its Predictors Among Patients With ST-Segment Elevation Myocardial Infarction Complicated by Shock

Insights From the GUSTO-I Trial

Mandeep Singh, MD^_*, Jennifer White, MS, David Hasdai, MD, Patricia K. Hodgson, BA, Peter B. Berger, MD, Eric J. Topol, MD^||, Robert M. Califf, MD and David R. Holmes, Jr, MD^_*,_*

^_* Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
Duke Clinical Research Institute, Durham, North Carolina
Rabin Medical Center, Petah Tikva, Israel
Geisinger Clinic, Danville, Pennsylvania
^|| Scripps Research Institute, La Jolla, California.

Manuscript received January 26, 2007; revised manuscript received April 16, 2007, accepted April 30, 2007.

^_* Reprint requests and correspondence: Dr. David R. Holmes, Jr., Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 1st Street SW, Rochester, Minnesota 55905. (Email: holmes.david{at}mayo.edu).

Objectives: This study sought to assess long-term outcome and determine its predictors among 30-day survivors of cardiogenic shock.

Background: Patients with cardiogenic shock have high in-hospital and 30-day mortality, but there are little data about those who survive beyond 30 days.

Methods: We analyzed baseline, in-hospital, and survival data from patients in the U.S. with ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock enrolled in the GUSTO (Global Utilization of Streptokinase and Tissue-Type Plasminogen Activator for Occluded Coronary Arteries)-I trial and compared them with patients in the same trial who did not have shock.

Results: Of 22,883 patients enrolled in the U.S., shock occurred in 1,891 (8.3%); 953 (50.4%) survived 30 days and 527 (27.8%) survived 11 years. Of 20,992 U.S. patients without shock, 20,360 (96.9%) survived 30 days and 14,131 (67.3%) survived 11 years. After the first year, 2% to 4% of patients died each year regardless of whether they had cardiogenic shock. Using Cox proportional hazards models, we were able to predict long-term mortality in all U.S. GUSTO-I 30-day survivors from their baseline demographics and in-hospital complications. The strongest predictors were diabetes mellitus, cardiogenic shock, hypertension, previous myocardial infarction, current smoking, anterior infarct, higher Killip class, higher heart rate, and older age; patients >75 years were at highest risk. Percutaneous revascularization during the index hospitalization was associated with a reduced risk of death.

Conclusions: Among patients with cardiogenic shock who survive 30 days after STEMI, annual mortality rates of 2% to 4% approximate those of patients without shock.

Abbreviations and Acronyms   MI = myocardial infarction   NDI = National Death Index   STEMI = ST-segment elevation myocardial infarction

Related Article

The Calm After the Storm: Long-Term Survival After Cardiogenic Shock

Judith S. Hochman and Renato Apolito
J. Am. Coll. Cardiol. 2007 50: 1759-1760. [Full Text] [PDF]

This article has been cited by other articles:

				M. Roik and G. Opolski Long-Term Outcome Among Patients With ST-Segment Elevation Myocardial Infarction Complicated by Shock J. Am. Coll. Cardiol., July 22, 2008; 52(4): 315 - 315. [Full Text] [PDF]

				D. R. Holmes Jr Reply J. Am. Coll. Cardiol., July 22, 2008; 52(4): 316 - 316. [Full Text] [PDF]

				D. J. Callans Can Home AEDs Improve Survival? N. Engl. J. Med., April 24, 2008; 358(17): 1853 - 1855. [Full Text] [PDF]

				G. H. Bardy, K. L. Lee, D. B. Mark, J. E. Poole, W. D. Toff, A. M. Tonkin, W. Smith, P. Dorian, D. L. Packer, R. D. White, et al. Home Use of Automated External Defibrillators for Sudden Cardiac Arrest N. Engl. J. Med., April 24, 2008; 358(17): 1793 - 1804. [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]

				A. N. DeMaria, J. J. Bax, O. Ben-Yehuda, P. Clopton, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, J. D. Knoke, W. Y.W. Lew, J. A.C. Lima, et al. Highlights of the year in JACC 2007. J. Am. Coll. Cardiol., January 29, 2008; 51(4): 490 - 512. [Full Text] [PDF]

				J. S. Hochman and R. Apolito The Calm After the Storm: Long-Term Survival After Cardiogenic Shock J. Am. Coll. Cardiol., October 30, 2007; 50(18): 1759 - 1760. [Full Text] [PDF]