Cardiogenic shock complicating acute myocardial infarction: Predictors of death☆,☆☆,★
Section snippets
Methods
The details and results of the GUSTO-I trial have been previously reported.17 In brief, 41,021 patients from 15 countries presenting within 6 hours of the onset of chest pain with typical electrocardiographic changes (>0.1 mV ST-segment elevation in ≥2 limb leads or >0.2 mV in ≥2 precordial leads) were eligible for randomization to 1 of 4 intravenous thrombolytic strategies: (1) streptokinase 1.5 million units over a 1-hour period with subcutaneous heparin; (2) streptokinase with intravenous
Results
Of the 41,021 patients enrolled in the GUSTO-I trial, there were missing data for shock status in 285 patients (0.7%). Shock occurred in 2972 patients (7.3%). Of the remaining 40,736 patients, 315 patients had shock on presentation (10.6%) and 2657 patients (89.4%) had shock develop after admission. The majority of patients who had shock develop after admission did so within 48 hours of admission.5 The demographic and clinical characteristics of the patients with cardiogenic shock and their
Discussion
In treating patients with acute myocardial infarction and cardiogenic shock, clinicians must make a number of difficult decisions concerning aggressiveness of care in the face of substantial uncertainty. Because of clear information that the mortality rate in these patients is high1, 2, 3, 4, 5, 6, 7, 24, 25 and that large amounts of resources can be expended in a futile effort, clinicians must consider withdrawal of aggressive measures in some of these patients. Alternatively, recent
References (29)
- et al.
Shock after acute myocardial infarction: a clinical and hemodynamic profile
Am J Cardiol
(1970) - et al.
Contemporary reperfusion therapy for cardiogenic shock: the GUSTO-I Trial experience
J Am Coll Cardiol
(1995) - et al.
Limitations of thrombolytic therapy for acute myocardial infarction complicated by congestive heart failure and cardiogenic shock
J Am Coll Cardiol
(1991) - et al.
Prognosis in cardiogenic shock after acute myocardial infarction in the interventional era
J Am Coll Cardiol
(1992) - et al.
Limits of reperfusion therapy for immediate cardiogenic shock complicating acute myocardial infarction
Am J Cardiol
(1994) - et al.
Studies on prolonged acute regional ischemia: V. metabolic support of remote myocardium during left ventricular power failure
J Thorac Cardiovasc Surg
(1989) - et al.
Early and 1-year survival rates in acute myocardial infarction complicated by cardiogenic shock: a retrospective study comparing coronary angioplasty with medical treatment
Am Heart J
(1995) - et al.
Usefulness of coronary stenting for cardiogenic shock
Am J Cardiol
(1997) - et al.
Differences in countries’ use of resources and clinical outcome for patients with cardiogenic shock after myocardial infarction: results from the GUSTO trial
Lancet
(1997) - et al.
Cardiogenic shock complicating acute myocardial infarction in patients without heart failure on admission: Incidence, risk factors, and outcome
Am J Med
(1993)
The in-hospital development of cardiogenic shock after myocardial infarction: incidence, predictors of occurrence, outcome and prognostic factors
J Am Coll Cardiol
Frequency of inclusion of patients with cardiogenic shock in trials of thrombolytic therapy
Am J Cardiol
Prognostic significance of the admission electrocardiogram in acute myocardial infarction
J Am Coll Cardiol
Cardiogenic shock
N Engl J Med
Cited by (162)
Right to Left Cardiac Power Output- New Prognosticator in STEMI Patients With Cardiogenic Shock (R-Shock)
2024, Current Problems in CardiologyClinical Characteristics and Outcomes of STEMI Patients With Cardiogenic Shock and Cardiac Arrest
2020, JACC: Cardiovascular InterventionsCardiogenic Shock Classification to Predict Mortality in the Cardiac Intensive Care Unit
2019, Journal of the American College of CardiologyOptimized Risk Score to Predict Mortality in Patients With Cardiogenic Shock in the Cardiac Intensive Care Unit
2023, Journal of the American Heart Association
- ☆
Supported by grants from Bayer (New York, NY), CIBA-Corning (Medfield, Mass), Genentech (South San Francisco, Calif), ICI Pharmaceuticals (Wilmington, Del), and Sanofi Pharmaceuticals (Paris, France).
- ☆☆
Reprint requests: David R. Holmes Jr, MD, Division of Internal Medicine and Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
- ★
0002-8703/99/$8.00 + 0 4/1/93718