August 14, 2026Journal of the American College of Cardiology158 citationsOpen Access
Correlates of one-year survival inpatients with cardiogenic shock complicating acute myocardial infarction
Key Result
In patients with cardiogenic shock, the hazard ratio for death per diseased vessel was 2.59 (95% CI 1.47-4.58) with medical stabilization and 1.11 (95% CI 0.79-1.56) with emergency revascularization.
Key Points
- To evaluate core laboratory angiographic characteristics and determine their association with one-year survival in patients with cardiogenic shock complicating acute myocardial infarction.
- Coronary angiography was analyzed from SHOCK trial participants assigned to emergency revascularization (ERV, n=147/152 [97%]) or initial medical stabilization (IMS, n=100/150 [67%]).
- Multivariate regression was conducted to assess the independent prognostic impact of angiographic variables, including vessel disease, TIMI flow grade, culprit vessel, and left ventricular ejection fraction (LVEF).
- LVEF correlated with one-year survival across both treatment groups (p < 0.001), whereas each additional diseased vessel significantly increased mortality in the IMS group (HR 2.59, 95% CI 1.47–4.58, p = 0.001) but not in the ERV group (HR 1.11, 95% CI 0.79–1.56, p = 0.559).
- In multivariate analysis of the full angiographic cohort, initial TIMI flow grade (p = 0.032), number of diseased vessels in IMS patients (p = 0.024), and culprit vessel (p = 0.004) independently predicted one-year survival.
- In the subcohort with measured LVEF (n = 97), both ejection fraction and culprit vessel remained independent correlates of one-year survival.
Study Design
Type
Cohort (n=302)
Structured PICO
P
Population
302 patients with cardiogenic shock complicating acute myocardial infarction from the SHOCK trial, followed for one year.
I
Intervention
Emergency revascularization
C
Comparator
Initial medical stabilization including thrombolysis and intraaortic balloon counterpulsation
O
Outcome
One-year survivalhard clinical
In patients with cardiogenic shock complicating acute myocardial infarction, left ventricular ejection fraction and the culprit vessel are independent predictors of one-year survival.
Main Result
Hazard Ratio: 2.59 (95% CI 1.47–4.58)
p-value: p=0.001
Abstract
OBJECTIVES: The goal of this study was to describe the core laboratory angiographic findings of "SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK" (SHOCK) trial participants and to determine the relationship of angiographic parameters to one-year survival. BACKGROUND: In the SHOCK trial, emergency revascularization improved one-year survival of patients with cardiogenic shock compared with initial medical stabilization including thrombolysis and intraaortic balloon counterpulsation. METHODS: Coronary angiography was performed by protocol in 147 of 152 (97%) patients in the emergency revascularization (ERV) group and by clinical selection in 100 of 150 (67%) patients in the initial medical stabilization (IMS) group. Of the other 50 IMS patients, 45 of 50 (90%) died rapidly and did not undergo angiography. RESULTS: Left ventricular ejection fraction was correlated with one-year survival in both treatment groups (p < 0.001). In the IMS group, the hazard ratio for death was 2.59 (95% confidence interval 1.47 to 4.58, p = 0.001) per diseased vessel (0/1 vs. 2 vs. 3). In the ERV group, the hazard ratio for death per diseased vessel was 1.11 (95% confidence interval 0.79 to 1.56, p = 0.559). Multivariate analysis of the angiography cohort (without regard for left ventriculogram measurements) identified initial Thrombolysis in Myocardial Infarction flow grade (p = 0.032), number of diseased vessels (for IMS patients only, p = 0.024), and culprit vessel (p = 0.004) as independent correlates of one-year survival, even after adjustment for key clinical factors. In the smaller cohort with left ventricular ejection fraction measured (n = 97), ejection fraction and culprit vessel remained independently correlated with survival. CONCLUSIONS: For patients in cardiogenic shock, left ventricular function and culprit vessel were independent correlates of one-year survival.