Percutaneous Coronary Intervention
Background: The SHOCK Registry prospectively enrolled patients with cardiogenic shock complicating acute myocardial infarction in 36 multinational centers.
Methods: Cardiogenic shock was predominantly attributable to left ventricular pump failure in 884 patients. Of these, 276 underwent percutaneous coronary intervention (PCI) after shock onset and are the subject of this report.
Results: The majority (78%) of patients undergoing angiography had multivessel disease. As the number of diseased arteries rose from 1 to 3, mortality rates rose from 34.2% to 51.2%. Patients who underwent PCI had lower in-hospital mortality rates than did patients treated medically (46.4% vs 78.0%, P < .001), even after adjustment for patient differences and survival bias (P = .037). Before PCI, the culprit artery was occluded (Thrombolysis In Myocardial Infarction grade 0 or 1 flow) in 76.3%. After PCI, the in-hospital mortality rate was 33.3% if reperfusion was complete (grade 3 flow), 50.0% with incomplete reperfusion (grade 2 flow), and 85.7% with absent reperfusion (grade 0 or 1 flow) (P < .001).
Conclusions: This prospective, multicenter registry of patients with acute myocardial infarction complicated by cardiogenic shock is consistent with a reduction in mortality rates as the result of percutaneous coronary revascularization. Coronary artery patency was an important predictor of outcome. Measures to promote early and rapid reperfusion appear critically important in improving the otherwise poor outcome associated with cardiogenic shock.
Cardiogenic shock is the major cause of death among patients admitted to the hospital with acute myocardial infarction (MI). The poor outcome with medical treatment alone has led to interest in percutaneous coronary intervention (PCI). The SHould we emergently revascularize Occluded coronaries for Cardiogenic shocK? (SHOCK) Registry was a prospective, multicenter registry of patients with known or suspected cardiogenic shock complicating acute MI who were not enrolled in the randomized SHOCK Trial. Through this registry, the role of PCI in the treatment of cardiogenic shock in a large and relatively unselected population was examined.
Background: The SHOCK Registry prospectively enrolled patients with cardiogenic shock complicating acute myocardial infarction in 36 multinational centers.
Methods: Cardiogenic shock was predominantly attributable to left ventricular pump failure in 884 patients. Of these, 276 underwent percutaneous coronary intervention (PCI) after shock onset and are the subject of this report.
Results: The majority (78%) of patients undergoing angiography had multivessel disease. As the number of diseased arteries rose from 1 to 3, mortality rates rose from 34.2% to 51.2%. Patients who underwent PCI had lower in-hospital mortality rates than did patients treated medically (46.4% vs 78.0%, P < .001), even after adjustment for patient differences and survival bias (P = .037). Before PCI, the culprit artery was occluded (Thrombolysis In Myocardial Infarction grade 0 or 1 flow) in 76.3%. After PCI, the in-hospital mortality rate was 33.3% if reperfusion was complete (grade 3 flow), 50.0% with incomplete reperfusion (grade 2 flow), and 85.7% with absent reperfusion (grade 0 or 1 flow) (P < .001).
Conclusions: This prospective, multicenter registry of patients with acute myocardial infarction complicated by cardiogenic shock is consistent with a reduction in mortality rates as the result of percutaneous coronary revascularization. Coronary artery patency was an important predictor of outcome. Measures to promote early and rapid reperfusion appear critically important in improving the otherwise poor outcome associated with cardiogenic shock.
Cardiogenic shock is the major cause of death among patients admitted to the hospital with acute myocardial infarction (MI). The poor outcome with medical treatment alone has led to interest in percutaneous coronary intervention (PCI). The SHould we emergently revascularize Occluded coronaries for Cardiogenic shocK? (SHOCK) Registry was a prospective, multicenter registry of patients with known or suspected cardiogenic shock complicating acute MI who were not enrolled in the randomized SHOCK Trial. Through this registry, the role of PCI in the treatment of cardiogenic shock in a large and relatively unselected population was examined.
SHARE
