European Heart Journal Advance Access originally published online on January 19, 2006
European Heart Journal 2006 27(6):664-670; doi:10.1093/eurheartj/ehi729
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Emergency revascularization in patients with cardiogenic shock on admission: a report from the SHOCK trial and registry
1Cardiovascular Clinical Research Center, New York University School of Medicine, 530 First Avenue, HCC 1173, New York, NY 10016, USA
2New England Research Institutes, Watertown, MA, USA
3Vancouver General Hospital, University of British Columbia, Vancouver, BC, USA
4Department of Cardiology, University Hospital, Basel, Switzerland
Received 24 July 2005; revised 14 December 2005; accepted 23 December 2005; online publish-ahead-of-print 19 January 2006.
* Corresponding author. Tel: +1 41 212 263 6927; fax: +1 41 212 263 7129. E-mail address: judith.hochman{at}med.nyu.edu
Aims To determine clinical correlates and optimal treatment strategy in patients with cardiogenic shock (CS) on admission.
Methods and results In SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK? (SHOCK) trial and registry patients with left ventricular (LV) dysfunction (n=1053), CS on admission occurred in 26% of directly admitted patients (n=166/627). Time from myocardial infarction to CS was shorter, initial haemodynamic profile poorer, and aggressive treatment less frequent in CS on admission than in delayed CS patients. CS on admission patients constituted a smaller relative proportion (11%) of the transferred (n=48/426) when compared with the directly admitted cohort (P<0.001). In-hospital mortality was higher (75 vs. 56%; P<0.001) with more rapid death (24-h mortality 40 vs. 17%; P<0.001) in CS on admission than in delayed CS patients. Emergency revascularization reduced in-hospital mortality in CS on admission (60 vs. 82%; P=0.001) and in delayed CS patients similarly (46 vs. 62%; P<0.001; interaction P=0.25). After adjustment for clinical differences, CS on admission was an independent predictor of in-hospital mortality (P=0.008).
Conclusion CS on admission patients have a worse outcome but benefit equally from emergency revascularization as delayed CS patients, emphasizing the need for rapid and direct access of CS on admission patients to facilities providing this care.
Key Words: Myocardial infarction • Shock, cardiogenic • Patient admission • Myocardial revascularization
CiteULike 
Connotea 
Del.icio.us What's this?
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]
|
|
|
|
 |
|
 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]
|
|
|
|
 |
|
 S. J. Walsh, C. G. Owens, and A. A. J. Adgey Pre-hospital diagnosis of myocardial infarction: an opportunity to improve outcomes? Eur. Heart J., July 1, 2006; 27(13): 1515 - 1516. [Full Text] [PDF]
|
|