Long-Term Outcome and its Predictors Among Patients With ST-Segment Elevation Myocardial Infarction Complicated by ShockInsights 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.
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Figure 1 Hazard Ratios for All 30-Day Survivors
Hazard ratios with (red circles) and without (blue squares) cardiogenic shock. Factors analyzed include baseline characteristics, cardiac history, treatment group, and procedures undergone during index hospitalization. All continuous variables (age, weight, height, heart rate, and systolic and diastolic blood pressure) were measured in units of 1 (e.g., respectively, 1 year, 1 kg, 1 cm, 1 beat/min, and 1 mm Hg), so that patients with a variable that measured 1 U greater than another patient had a hazard of mortality as reflected in the figure. For example, a nonshock 65-year-old patient had a 1.06 greater hazard of dying than a nonshock 64-year-old patient. BP = blood pressure; CABG = coronary artery bypass grafting; CVD = cerebrovascular disease; dia = diastolic; IABP = intra-aortic balloon pump; IV Hep = intravenous heparin; MI = myocardial infarction; PTCA = percutaneous transluminal coronary angioplasty; SK = streptokinase; SubQ Hep = subcutaneous heparin; sys = systolic; t-PA = tissue plasminogen activator.
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Figure 2 Kaplan-Meier Mortality Curve in 30-Day Survivors of STEMI
The Kaplan-Meier mortality estimate at 11 years is 44.8% (95% confidence interval 41.6 to 47.9) in patients with (red line)and 30.6% (95% confidence interval 29.9 to 31.2) in patients without (blue line) shock. STEMI = ST-segment elevation myocardial infarction.
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Figure 3 Bar Graph Showing Annual Mortality in STEMI Patients Presenting With and Without Shock
Mortality rates beyond the first year are similar. STEMI = ST-segment elevation myocardial infarction.
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