In 1,190 registry patients with cardiogenic shock complicating acute MI, in-hospital mortality was 60%, and early revascularization showed a survival benefit similar to the randomized SHOCK trial.
Observational (n=1,190)
Does early revascularization improve survival in a real-world registry of patients with cardiogenic shock complicating acute MI?
In a real-world registry of cardiogenic shock complicating acute MI, early revascularization was associated with a survival benefit similar to that seen in the randomized SHOCK Trial, supporting its generalizability.
OBJECTIVES: This SHOCK Study report seeks to provide an overview of patients with cardiogenic shock (CS) complicating acute myocardial infarction (MI) and the outcome with various treatments. The outcome of patients undergoing revascularization in the SHOCK Trial Registry and SHOCK Trial are compared. BACKGROUND: Cardiogenic shock is the leading cause of death in patients hospitalized for acute MI. The randomized SHOCK Trial reported improved six-month survival with early revascularization. METHODS: Patients with CS complicating acute MI who were not enrolled in the concurrent randomized trial were registered. Patient characteristics were recorded as were procedures and vital status at hospital discharge. RESULTS: Between April 1993 and August 1997, 1,190 patients with CS were registered and 232 were randomized in the SHOCK Trial. Predominant left ventricular failure (78.5%) was most common, with isolated right ventricular shock in 2.8%, severe mitral regurgitation in 6.9%, ventricular septal rupture in 3.9% and tamponade in 1.4%. In-hospital Registry mortality was 60%, with ventricular septal rupture associated with a significantly higher mortality (87.3%) than all other categories (p < 0.01). The risk profile and mortality were lower for Registry patients who were managed with thrombolytic therapy and/or intra-aortic balloon counter-pulsation, coronary angiography, angioplasty and/or coronary artery bypass surgery. After adjusting for these differences, the extent to which survival was improved with early revascularization was similar to that observed in the randomized SHOCK Trial. CONCLUSIONS: In this prospective Registry the etiology of CS was a mechanical complication in 12%. The similarity of the beneficial treatment effect in patients undergoing early revascularization in the SHOCK Trial Registry and SHOCK Trial provides strong support for the generalizability of the SHOCK Trial results.
Hochman et al. (2000) conducted an observational in Cardiogenic shock complicating acute myocardial infarction (n=1,190). Early revascularization was evaluated on In-hospital mortality. In 1,190 registry patients with cardiogenic shock complicating acute MI, in-hospital mortality was 60%, and early revascularization showed a survival benefit similar to the randomized SHOCK trial.