Cardiogenic shock due to cardiac free-wall rupture or tamponade after acute myocardial infarction: A report from the SHOCK Trial Registry

James Slater, Robert J. Brown, Tracy A. Antonelli, Venu Menon, Jean Boland, Jacques Col, Vladimir Dzavik, Mark A. Greenberg, Mark A. Menegus, Cliff Connery, Judith S. Hochman

Research output: Contribution to journalArticle

106 Citations (Scopus)

Abstract

OBJECTIVES: We sought to compare the characteristics and outcomes of patients with acute myocardial infarction (MI) and cardiogenic shock (CS) caused by rupture of the ventricular free wall or tamponade versus shock from other causes. BACKGROUND: Free-wall rupture is a recognized cause of mortality in patients with acute MI. Some of these patients present subacutely, which provides an opportunity for intervention. Recognition of factors that distinguish them from the overall shock cohort would be beneficial. METHODS: The international SHOCK Trial Registry enrolled patients concurrently with the randomized SHOCK Trial. Thirty-six centers consecutively enrolled all patients with suspected CS after MI, regardless of trial eligibility. RESULTS: Of the 1,048 patients studied, 28 (2.7%) had free-wall rupture or tamponade. These patients had less pulmonary edema, less diabetes, less prior MI, and less prior congestive heart failure (all p < 0.05). They more often had new Q waves in two or more leads (51.9% vs. 31.5%, p < 0.04), but MI location and time to shock onset after MI did not differ. Of patients with rupture or tamponade, 75% had pericardial effusions. No hemodynamic characteristics identified patients with rupture/tamponade. Most patients with rupture/tamponade had surgery and/or pericardiocentesis (27/28); their in-hospital survival rate was identical to that of the group overall (39.3%). Women and older patients with rupture/tamponade tended to survive intervention less often. CONCLUSIONS: Free-wall rupture and tamponade may present as CS after MI, and survival after intervention is similar to that of the overall shock cohort. All patients with CS after MI should have echocardiography in order to detect subacute rupture or tamponade and initiate appropriate interventions. (C) 2000 by the American College of Cardiology.

Original languageEnglish (US)
Pages (from-to)1117-1122
Number of pages6
JournalJournal of the American College of Cardiology
Volume36
Issue number3 SUPPL. A
DOIs
StatePublished - 2000

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Heart Rupture
Cardiogenic Shock
Registries
Myocardial Infarction
Rupture
Shock
Pericardiocentesis
Pericardial Effusion
Pulmonary Edema
Echocardiography

ASJC Scopus subject areas

  • Nursing(all)

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Cardiogenic shock due to cardiac free-wall rupture or tamponade after acute myocardial infarction : A report from the SHOCK Trial Registry. / Slater, James; Brown, Robert J.; Antonelli, Tracy A.; Menon, Venu; Boland, Jean; Col, Jacques; Dzavik, Vladimir; Greenberg, Mark A.; Menegus, Mark A.; Connery, Cliff; Hochman, Judith S.

In: Journal of the American College of Cardiology, Vol. 36, No. 3 SUPPL. A, 2000, p. 1117-1122.

Research output: Contribution to journalArticle

Slater, James ; Brown, Robert J. ; Antonelli, Tracy A. ; Menon, Venu ; Boland, Jean ; Col, Jacques ; Dzavik, Vladimir ; Greenberg, Mark A. ; Menegus, Mark A. ; Connery, Cliff ; Hochman, Judith S. / Cardiogenic shock due to cardiac free-wall rupture or tamponade after acute myocardial infarction : A report from the SHOCK Trial Registry. In: Journal of the American College of Cardiology. 2000 ; Vol. 36, No. 3 SUPPL. A. pp. 1117-1122.
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abstract = "OBJECTIVES: We sought to compare the characteristics and outcomes of patients with acute myocardial infarction (MI) and cardiogenic shock (CS) caused by rupture of the ventricular free wall or tamponade versus shock from other causes. BACKGROUND: Free-wall rupture is a recognized cause of mortality in patients with acute MI. Some of these patients present subacutely, which provides an opportunity for intervention. Recognition of factors that distinguish them from the overall shock cohort would be beneficial. METHODS: The international SHOCK Trial Registry enrolled patients concurrently with the randomized SHOCK Trial. Thirty-six centers consecutively enrolled all patients with suspected CS after MI, regardless of trial eligibility. RESULTS: Of the 1,048 patients studied, 28 (2.7{\%}) had free-wall rupture or tamponade. These patients had less pulmonary edema, less diabetes, less prior MI, and less prior congestive heart failure (all p < 0.05). They more often had new Q waves in two or more leads (51.9{\%} vs. 31.5{\%}, p < 0.04), but MI location and time to shock onset after MI did not differ. Of patients with rupture or tamponade, 75{\%} had pericardial effusions. No hemodynamic characteristics identified patients with rupture/tamponade. Most patients with rupture/tamponade had surgery and/or pericardiocentesis (27/28); their in-hospital survival rate was identical to that of the group overall (39.3{\%}). Women and older patients with rupture/tamponade tended to survive intervention less often. CONCLUSIONS: Free-wall rupture and tamponade may present as CS after MI, and survival after intervention is similar to that of the overall shock cohort. All patients with CS after MI should have echocardiography in order to detect subacute rupture or tamponade and initiate appropriate interventions. (C) 2000 by the American College of Cardiology.",
author = "James Slater and Brown, {Robert J.} and Antonelli, {Tracy A.} and Venu Menon and Jean Boland and Jacques Col and Vladimir Dzavik and Greenberg, {Mark A.} and Menegus, {Mark A.} and Cliff Connery and Hochman, {Judith S.}",
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T1 - Cardiogenic shock due to cardiac free-wall rupture or tamponade after acute myocardial infarction

T2 - A report from the SHOCK Trial Registry

AU - Slater, James

AU - Brown, Robert J.

AU - Antonelli, Tracy A.

AU - Menon, Venu

AU - Boland, Jean

AU - Col, Jacques

AU - Dzavik, Vladimir

AU - Greenberg, Mark A.

AU - Menegus, Mark A.

AU - Connery, Cliff

AU - Hochman, Judith S.

PY - 2000

Y1 - 2000

N2 - OBJECTIVES: We sought to compare the characteristics and outcomes of patients with acute myocardial infarction (MI) and cardiogenic shock (CS) caused by rupture of the ventricular free wall or tamponade versus shock from other causes. BACKGROUND: Free-wall rupture is a recognized cause of mortality in patients with acute MI. Some of these patients present subacutely, which provides an opportunity for intervention. Recognition of factors that distinguish them from the overall shock cohort would be beneficial. METHODS: The international SHOCK Trial Registry enrolled patients concurrently with the randomized SHOCK Trial. Thirty-six centers consecutively enrolled all patients with suspected CS after MI, regardless of trial eligibility. RESULTS: Of the 1,048 patients studied, 28 (2.7%) had free-wall rupture or tamponade. These patients had less pulmonary edema, less diabetes, less prior MI, and less prior congestive heart failure (all p < 0.05). They more often had new Q waves in two or more leads (51.9% vs. 31.5%, p < 0.04), but MI location and time to shock onset after MI did not differ. Of patients with rupture or tamponade, 75% had pericardial effusions. No hemodynamic characteristics identified patients with rupture/tamponade. Most patients with rupture/tamponade had surgery and/or pericardiocentesis (27/28); their in-hospital survival rate was identical to that of the group overall (39.3%). Women and older patients with rupture/tamponade tended to survive intervention less often. CONCLUSIONS: Free-wall rupture and tamponade may present as CS after MI, and survival after intervention is similar to that of the overall shock cohort. All patients with CS after MI should have echocardiography in order to detect subacute rupture or tamponade and initiate appropriate interventions. (C) 2000 by the American College of Cardiology.

AB - OBJECTIVES: We sought to compare the characteristics and outcomes of patients with acute myocardial infarction (MI) and cardiogenic shock (CS) caused by rupture of the ventricular free wall or tamponade versus shock from other causes. BACKGROUND: Free-wall rupture is a recognized cause of mortality in patients with acute MI. Some of these patients present subacutely, which provides an opportunity for intervention. Recognition of factors that distinguish them from the overall shock cohort would be beneficial. METHODS: The international SHOCK Trial Registry enrolled patients concurrently with the randomized SHOCK Trial. Thirty-six centers consecutively enrolled all patients with suspected CS after MI, regardless of trial eligibility. RESULTS: Of the 1,048 patients studied, 28 (2.7%) had free-wall rupture or tamponade. These patients had less pulmonary edema, less diabetes, less prior MI, and less prior congestive heart failure (all p < 0.05). They more often had new Q waves in two or more leads (51.9% vs. 31.5%, p < 0.04), but MI location and time to shock onset after MI did not differ. Of patients with rupture or tamponade, 75% had pericardial effusions. No hemodynamic characteristics identified patients with rupture/tamponade. Most patients with rupture/tamponade had surgery and/or pericardiocentesis (27/28); their in-hospital survival rate was identical to that of the group overall (39.3%). Women and older patients with rupture/tamponade tended to survive intervention less often. CONCLUSIONS: Free-wall rupture and tamponade may present as CS after MI, and survival after intervention is similar to that of the overall shock cohort. All patients with CS after MI should have echocardiography in order to detect subacute rupture or tamponade and initiate appropriate interventions. (C) 2000 by the American College of Cardiology.

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