Current spectrum of cardiogenic shock and effect of early revascularization on mortality results of an international registry

Judith S. Hochman, Jean Boland, Lynn A. Sleeper, Mark Porway, Jeffrey Brinker, Jacques Col, Alice Jacobs, James Slater, David Miller, Hal Wasserman, Mark A. Menegus, J. David Talley, Sonja McKinlay, Timothy Sanborn, Thierry LeJemtel

Research output: Contribution to journalArticle

314 Citations (Scopus)

Abstract

Background: Cardiogenic shock remains the leading cause of death of patients hospitalized with acute myocardial infarction (MI). This study was conducted to examine (1) the current spectrum of cardiogenic shock, (2) the proportion of patients who are potential candidates for a trial of early revascularization, and (3) the apparent impact of early revascularization on mortality. Methods and Results: Nineteen participating centers in the United States and Belgium prospectively registered all patients diagnosed with cardiogenic shock. Two hundred fifty-one patients were registered. The mean age was 67.5±11.7 years, and 43% were women. Acute mitral regurgitation or ventricular septal rupture was the cause of shock in 8%. Concurrent conditions contributing to the development of shock were noted in 5%, and 2% had isolated right ventricular shock. Among the remaining 214 patients, nonspecific findings on the ECG associated with "nontransmural" MI were seen in 14%. The median time to shock diagnosis after MI was 8 hours. The overall in-hospital mortality was 66%. Patients clinically selected to undergo cardiac catheterization were significantly younger and had a lower mortality than those not selected (51% versus 85%, P<.0001) even if they were not revascularized (58%). Mortality for patients undergoing percutaneous transluminal coronary angioplasty (PTCA) was 60% (n=55) and 19% (n=16) for coronary artery bypass graft surgery (CABG). Sixty percent (n=150) of registered patients were judged eligible for a trial of early revascularization. Trial-eligible patients were significantly younger (65.4±11.0 versus 70.6±11.9 years, P<.001), had an earlier median time to shock onset after MI (6.5 versus 17.5 hours, P=.003), and had lower mortality (62% versus 73%, P= .077) than ineligible patients. Conclusions: Patients diagnosed with cardiogenic shock complicating acute MI are a heterogeneous group. Those eligible for a trial of early revascularization tended to have lower mortality. Patients selected to undergo cardiac catheterization had lower mortality whether or not they were revascularized. Emergent PTCA and CABG are promising treatment modalities for cardiogenic shock, but biased case selection for treatment may confound the data. Whether PTCA and CABG reduce mortality and which patient subgroups benefit most remain to be determined in a randomized clinical trial.

Original languageEnglish (US)
Pages (from-to)873-881
Number of pages9
JournalCirculation
Volume91
Issue number3
StatePublished - Feb 1 1995
Externally publishedYes

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Cardiogenic Shock
Registries
Mortality
Shock
Myocardial Infarction
Coronary Balloon Angioplasty
Coronary Artery Bypass
Cardiac Catheterization
Transplants
Ventricular Septal Rupture
Belgium
Mitral Valve Insufficiency
Hospital Mortality
Patient Selection
Cause of Death
Electrocardiography
Randomized Controlled Trials

Keywords

  • Angioplasty
  • Myocardial infarction
  • Revascularization
  • Shock

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Hochman, J. S., Boland, J., Sleeper, L. A., Porway, M., Brinker, J., Col, J., ... LeJemtel, T. (1995). Current spectrum of cardiogenic shock and effect of early revascularization on mortality results of an international registry. Circulation, 91(3), 873-881.

Current spectrum of cardiogenic shock and effect of early revascularization on mortality results of an international registry. / Hochman, Judith S.; Boland, Jean; Sleeper, Lynn A.; Porway, Mark; Brinker, Jeffrey; Col, Jacques; Jacobs, Alice; Slater, James; Miller, David; Wasserman, Hal; Menegus, Mark A.; Talley, J. David; McKinlay, Sonja; Sanborn, Timothy; LeJemtel, Thierry.

In: Circulation, Vol. 91, No. 3, 01.02.1995, p. 873-881.

Research output: Contribution to journalArticle

Hochman, JS, Boland, J, Sleeper, LA, Porway, M, Brinker, J, Col, J, Jacobs, A, Slater, J, Miller, D, Wasserman, H, Menegus, MA, Talley, JD, McKinlay, S, Sanborn, T & LeJemtel, T 1995, 'Current spectrum of cardiogenic shock and effect of early revascularization on mortality results of an international registry', Circulation, vol. 91, no. 3, pp. 873-881.
Hochman JS, Boland J, Sleeper LA, Porway M, Brinker J, Col J et al. Current spectrum of cardiogenic shock and effect of early revascularization on mortality results of an international registry. Circulation. 1995 Feb 1;91(3):873-881.
Hochman, Judith S. ; Boland, Jean ; Sleeper, Lynn A. ; Porway, Mark ; Brinker, Jeffrey ; Col, Jacques ; Jacobs, Alice ; Slater, James ; Miller, David ; Wasserman, Hal ; Menegus, Mark A. ; Talley, J. David ; McKinlay, Sonja ; Sanborn, Timothy ; LeJemtel, Thierry. / Current spectrum of cardiogenic shock and effect of early revascularization on mortality results of an international registry. In: Circulation. 1995 ; Vol. 91, No. 3. pp. 873-881.
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abstract = "Background: Cardiogenic shock remains the leading cause of death of patients hospitalized with acute myocardial infarction (MI). This study was conducted to examine (1) the current spectrum of cardiogenic shock, (2) the proportion of patients who are potential candidates for a trial of early revascularization, and (3) the apparent impact of early revascularization on mortality. Methods and Results: Nineteen participating centers in the United States and Belgium prospectively registered all patients diagnosed with cardiogenic shock. Two hundred fifty-one patients were registered. The mean age was 67.5±11.7 years, and 43{\%} were women. Acute mitral regurgitation or ventricular septal rupture was the cause of shock in 8{\%}. Concurrent conditions contributing to the development of shock were noted in 5{\%}, and 2{\%} had isolated right ventricular shock. Among the remaining 214 patients, nonspecific findings on the ECG associated with {"}nontransmural{"} MI were seen in 14{\%}. The median time to shock diagnosis after MI was 8 hours. The overall in-hospital mortality was 66{\%}. Patients clinically selected to undergo cardiac catheterization were significantly younger and had a lower mortality than those not selected (51{\%} versus 85{\%}, P<.0001) even if they were not revascularized (58{\%}). Mortality for patients undergoing percutaneous transluminal coronary angioplasty (PTCA) was 60{\%} (n=55) and 19{\%} (n=16) for coronary artery bypass graft surgery (CABG). Sixty percent (n=150) of registered patients were judged eligible for a trial of early revascularization. Trial-eligible patients were significantly younger (65.4±11.0 versus 70.6±11.9 years, P<.001), had an earlier median time to shock onset after MI (6.5 versus 17.5 hours, P=.003), and had lower mortality (62{\%} versus 73{\%}, P= .077) than ineligible patients. Conclusions: Patients diagnosed with cardiogenic shock complicating acute MI are a heterogeneous group. Those eligible for a trial of early revascularization tended to have lower mortality. Patients selected to undergo cardiac catheterization had lower mortality whether or not they were revascularized. Emergent PTCA and CABG are promising treatment modalities for cardiogenic shock, but biased case selection for treatment may confound the data. Whether PTCA and CABG reduce mortality and which patient subgroups benefit most remain to be determined in a randomized clinical trial.",
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T1 - Current spectrum of cardiogenic shock and effect of early revascularization on mortality results of an international registry

AU - Hochman, Judith S.

AU - Boland, Jean

AU - Sleeper, Lynn A.

AU - Porway, Mark

AU - Brinker, Jeffrey

AU - Col, Jacques

AU - Jacobs, Alice

AU - Slater, James

AU - Miller, David

AU - Wasserman, Hal

AU - Menegus, Mark A.

AU - Talley, J. David

AU - McKinlay, Sonja

AU - Sanborn, Timothy

AU - LeJemtel, Thierry

PY - 1995/2/1

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N2 - Background: Cardiogenic shock remains the leading cause of death of patients hospitalized with acute myocardial infarction (MI). This study was conducted to examine (1) the current spectrum of cardiogenic shock, (2) the proportion of patients who are potential candidates for a trial of early revascularization, and (3) the apparent impact of early revascularization on mortality. Methods and Results: Nineteen participating centers in the United States and Belgium prospectively registered all patients diagnosed with cardiogenic shock. Two hundred fifty-one patients were registered. The mean age was 67.5±11.7 years, and 43% were women. Acute mitral regurgitation or ventricular septal rupture was the cause of shock in 8%. Concurrent conditions contributing to the development of shock were noted in 5%, and 2% had isolated right ventricular shock. Among the remaining 214 patients, nonspecific findings on the ECG associated with "nontransmural" MI were seen in 14%. The median time to shock diagnosis after MI was 8 hours. The overall in-hospital mortality was 66%. Patients clinically selected to undergo cardiac catheterization were significantly younger and had a lower mortality than those not selected (51% versus 85%, P<.0001) even if they were not revascularized (58%). Mortality for patients undergoing percutaneous transluminal coronary angioplasty (PTCA) was 60% (n=55) and 19% (n=16) for coronary artery bypass graft surgery (CABG). Sixty percent (n=150) of registered patients were judged eligible for a trial of early revascularization. Trial-eligible patients were significantly younger (65.4±11.0 versus 70.6±11.9 years, P<.001), had an earlier median time to shock onset after MI (6.5 versus 17.5 hours, P=.003), and had lower mortality (62% versus 73%, P= .077) than ineligible patients. Conclusions: Patients diagnosed with cardiogenic shock complicating acute MI are a heterogeneous group. Those eligible for a trial of early revascularization tended to have lower mortality. Patients selected to undergo cardiac catheterization had lower mortality whether or not they were revascularized. Emergent PTCA and CABG are promising treatment modalities for cardiogenic shock, but biased case selection for treatment may confound the data. Whether PTCA and CABG reduce mortality and which patient subgroups benefit most remain to be determined in a randomized clinical trial.

AB - Background: Cardiogenic shock remains the leading cause of death of patients hospitalized with acute myocardial infarction (MI). This study was conducted to examine (1) the current spectrum of cardiogenic shock, (2) the proportion of patients who are potential candidates for a trial of early revascularization, and (3) the apparent impact of early revascularization on mortality. Methods and Results: Nineteen participating centers in the United States and Belgium prospectively registered all patients diagnosed with cardiogenic shock. Two hundred fifty-one patients were registered. The mean age was 67.5±11.7 years, and 43% were women. Acute mitral regurgitation or ventricular septal rupture was the cause of shock in 8%. Concurrent conditions contributing to the development of shock were noted in 5%, and 2% had isolated right ventricular shock. Among the remaining 214 patients, nonspecific findings on the ECG associated with "nontransmural" MI were seen in 14%. The median time to shock diagnosis after MI was 8 hours. The overall in-hospital mortality was 66%. Patients clinically selected to undergo cardiac catheterization were significantly younger and had a lower mortality than those not selected (51% versus 85%, P<.0001) even if they were not revascularized (58%). Mortality for patients undergoing percutaneous transluminal coronary angioplasty (PTCA) was 60% (n=55) and 19% (n=16) for coronary artery bypass graft surgery (CABG). Sixty percent (n=150) of registered patients were judged eligible for a trial of early revascularization. Trial-eligible patients were significantly younger (65.4±11.0 versus 70.6±11.9 years, P<.001), had an earlier median time to shock onset after MI (6.5 versus 17.5 hours, P=.003), and had lower mortality (62% versus 73%, P= .077) than ineligible patients. Conclusions: Patients diagnosed with cardiogenic shock complicating acute MI are a heterogeneous group. Those eligible for a trial of early revascularization tended to have lower mortality. Patients selected to undergo cardiac catheterization had lower mortality whether or not they were revascularized. Emergent PTCA and CABG are promising treatment modalities for cardiogenic shock, but biased case selection for treatment may confound the data. Whether PTCA and CABG reduce mortality and which patient subgroups benefit most remain to be determined in a randomized clinical trial.

KW - Angioplasty

KW - Myocardial infarction

KW - Revascularization

KW - Shock

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