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Cardiogenic shock complicating acute myocardial infarction—etiologies, management and outcome: a report from the SHOCK Trial Registry

Judith S. Hochman, MD, FACC^*, Christopher E. Buller, MD, FACC, Lynn A. Sleeper, ScD, Jean Boland, MD, Vladimir Dzavik, MD^||, Timothy A. Sanborn, MD, FACC^¶, Emilie Godfrey, MS, RD^*, Harvey D. White, DSc, FACC, John Lim, BA, Thierry LeJemtel, MD^** for the SHOCK Investigators

^* St. Luke’s–Roosevelt Hospital Center and Columbia University, New York, New York, USA
Vancouver Hospital & Science Center, Laurel Cardiology, Vancouver, British Columbia, Canada
New England Research Institutes, Watertown, Massachusetts, USA
CHR Citadelle, Department of Cardiology, Liège, Belgium
^|| University of Alberta, Div. of Cardiology, Edmonton, Canada
^¶ New York Cornell Medical Center, New York, New York, USA
Green Lane Hospital, Auckland, New Zealand
^** Albert Einstein Medical Center (College of Medicine), New York, New York, USA

View larger version (29K): [in a new window]   Figure 1 The complete population of all shock patients screened, including 1,190 Registered patients and 232 Trial patients randomized concurrent with the Registry from 4/93 – 8/97, is represented in the figure. Of the 1,116 patients with LVF, 844 were Registry and 232 were Trial. The mortality rates for the 1,190 Registry patients and 884 LVF Registry patients are 61.4% and 60.8%, respectively. The incidence (%, below each bar) and mortality for the major shock categories is shown. LVF = predominant LV failure (see Methods section), RVF = isolated RV shock, MR = acute severe mitral regurgitation, VSR = ventricular septal rupture, Tamp = cardiac tamponade/rupture. Other causes are described in the methods section. The categorization of cardiogenic shock was unknown in four patients who had a 75% mortality rate. Between group comparisons are based on hierarchical groups in order from left to right. Six patients fell into more than one category (see text).

View larger version (17K): [in a new window]   Figure 2 Patients with predominant LV failure clinically selected to undergo left heart catheterization and coronary angiography (LH cath) had a lower mortality than those with no LH cath. Patients with no revascularization attempt had higher mortality, with the lowest mortality observed in patients selected to undergo CABG. The CABG group includes 18 patients who underwent CABG post-PTCA; these patients are not included in the PTCA group. The mortality rates for those undergoing early revascularization (within 18 h of shock diagnosis), at a time comparable to the randomized SHOCK Trial, are shown. The median times to PTCA and CABG are 2.8 and 3.9 h, respectively, for those revascularized <18 h post-shock. *Patients with PTCA or CABG prior to shock are excluded.