Emergency revascularization significantly reduced in-hospital mortality in patients with cardiogenic shock on admission (60% vs 82%, P=0.001), with similar benefits seen in delayed shock patients.
Cohort (n=1,053)
Does emergency revascularization reduce in-hospital mortality in patients with cardiogenic shock on admission?
Patients with cardiogenic shock on admission have higher mortality but derive similar benefit from emergency revascularization as those with delayed cardiogenic shock.
Absolute Event Rate: 60% vs 82%
p-value: p=0.001
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.
Jeger et al. (2006) conducted a cohort in Cardiogenic shock (n=1,053). Emergency revascularization vs. No emergency revascularization was evaluated on In-hospital mortality (p=0.001). Emergency revascularization significantly reduced in-hospital mortality in patients with cardiogenic shock on admission (60% vs 82%, P=0.001), with similar benefits seen in delayed shock patients.