Prognosis in cardiogenic shock after acute myocardial infarction in the interventional era

• Published in: Journal of the American College of Cardiology Vol. 20; no. 7; pp. 1482 - 1489
• Main Authors: BENGTSON, J. R, KAPLAN, A. J, PIEPER, K. S, WILDERMANN, N. M, MARK, D. B, PRYOR, D. B, PHILLIPS, H. R, CALIFF, R. M
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Science 01.12.1992
• Subjects: Academic Medical Centers; Age Factors; Aged; Angioplasty, Balloon, Coronary - standards; Biological and medical sciences; Cardiac Catheterization; Cardiac Output; Cardiology. Vascular system; Cardiotonic Agents - therapeutic use; Combined Modality Therapy; Coronary Angiography; Coronary heart disease; Creatine Kinase - blood; Decision Trees; Female; Follow-Up Studies; Heart; Hospital Mortality; Humans; Intra-Aortic Balloon Pumping - standards; Isoenzymes; Logistic Models; Male; Medical sciences; Middle Aged; Myocardial Infarction - complications; Myocardial Infarction - diagnosis; Myocardial Reperfusion - methods; Myocardial Reperfusion - standards; North Carolina - epidemiology; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Prospective Studies; Shock, Cardiogenic - etiology; Shock, Cardiogenic - mortality; Shock, Cardiogenic - therapy; Stroke Volume; Survival Analysis; Thrombolytic Therapy - standards; Treatment Outcome; Vasoconstrictor Agents - therapeutic use; North Carolina; Human; Intensive cardiocirculatory care; Prognosis; Treatment; Infarct; Cardiogenic shock; Mortality; Myocardium; Cardiovascular disease; Complication; Coronary heart disease
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(92)90440-X

The purpose of this study is to describe the outcome in cardiogenic shock treated with aggressive reperfusion therapy and to identify factors predictive of in-hospital and long-term mortality. Cardiogenic shock is the most common cause of death in patients admitted to the coronary care unit. Although studies have reported lower mortality rates in shock treated with angioplasty, few studies have described a cohort of patients with shock who were not selected because they were most likely to benefit from reperfusion therapy. A consecutive series of 200 patients admitted with acute myocardial infarction complicated by cardiogenic shock were studied. The in-hospital mortality rate was 53%. Variables with significant univariable association with in-hospital death included patency of the infarct-related artery, patient age, lowest cardiac index, highest arteriovenous oxygen difference and left main coronary artery disease. The most important independent predictors of in-hospital death were patency of the infarct-related artery, cardiac index and peak creatine kinase, MB fraction. The mortality rate in patients with patent infarct-related arteries was 33% versus 75% in those with closed arteries and 84% in those in whom arterial patency was unknown. Patients who survived to hospital discharge were followed up for a median of 2 years, with a mortality rate of 18% after 1 year. The best descriptors of the relation between these variables and postdischarge mortality included age, peak creatine kinase, ejection fraction and patency of the infarct-related artery. In a large consecutive series of patients with cardiogenic shock with complete follow-up, patency of the infarct-related artery was most strongly associated with in-hospital and long-term mortality. This finding supports an aggressive interventional strategy in patients with cardiogenic shock.