Impact of thrombolysis, intra-aortic balloon pump counterpulsation, and their combination in cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry
Key result
Thrombolysis and IABP linked to ~39% lower in-hospital mortality in MI-related cardiogenic shock.
- P<0.0001
- n=856
Why the study?
Whether adding IABP support to thrombolytic therapy lowers in-hospital mortality in patients with cardiogenic shock complicating MI had not been examined prospectively in a study devoted to cardiogenic shock.
Does thrombolytic therapy, intra-aortic balloon pump counterpulsation, or their combination reduce in-hospital mortality in patients with cardiogenic shock complicating acute myocardial infarction?
Population
856 patients with cardiogenic shock due to predominant LV failure complicating acute MI across 36 centers
Comparison
TT and IABP vs IABP only vs TT only vs no TT, no IABP
Design
Prospective multi-center registry
Authors
Discussion
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Member takes
Implication
May support TT+IABP consideration in MI shock; leaves open whether association reflects causation or bias.
Study Design
Type
Observational (n=856)
Multicenter
Yes
Structured PICO
Does thrombolytic therapy, intra-aortic balloon pump counterpulsation, or their combination reduce in-hospital mortality in patients with cardiogenic shock complicating acute myocardial infarction?
P
Population
856 patients with acute myocardial infarction complicated by cardiogenic shock due to predominant left ventricular failure evaluated during their hospital stay.
E
Exposure
Thrombolytic therapy (TT), intra-aortic balloon pump counterpulsation (IABP), or their combination (TT + IABP).
C
Comparator
No thrombolytic therapy and no IABP (standard medical therapy).
O
Outcome
In-hospital mortalityhard clinical
Main Result
Absolute Event Rate: 47% vs 77%
p-value: p=<0.0001
In patients with cardiogenic shock complicating acute myocardial infarction, the use of thrombolytic therapy, IABP, and revascularization is associated with significantly lower in-hospital mortality compared to standard medical therapy.
Limitations
- Selection bias is evident
- Selection bias
Cite This Study
Sanborn et al. (2000) conducted an observational in Acute myocardial infarction complicated by cardiogenic shock (n=856). Thrombolytic therapy and intra-aortic balloon pump counterpulsation vs. No thrombolytic therapy and no intra-aortic balloon pump was evaluated on In-hospital mortality (p=<0.0001). Treatment with thrombolytic therapy and IABP was associated with lower in-hospital mortality (47%) compared to no TT and no IABP (77%, p<0.0001) in patients with cardiogenic shock complicating MI.