Cardiogenic shock caused by right ventricular infarction
Key result
Predominant RV shock is linked to similar in-hospital mortality compared to LV shock.
- OR 1.07
- 95% CI 0.54 to 2.13
- P=0.296
- n=933
Why the study?
Although right ventricular infarction has been shown to have favorable long-term outcomes, the influence of right ventricular infarction on mortality in cardiogenic shock was unknown.
Population
933 patients in cardiogenic shock due to predominant RV or LV failure in the SHOCK trial registry
Comparison
Predominant RV shock vs predominant LV shock
Design
Registry-based cohort study
Authors
Discussion
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Implication
Registry study reveals unexpectedly high in-hospital mortality in patients with right ventricular cardiogenic shock, indicating outcomes comparable to left ventricular shock.
Key Points
- To determine the clinical characteristics and mortality outcomes of patients suffering from acute myocardial infarction complicated by cardiogenic shock due to predominant right ventricular failure.
- Evaluated 933 patients presenting with cardiogenic shock due to predominant right ventricular failure (n = 49) or left ventricular failure (n = 884) from the SHOCK trial registry.
- Compared patient demographics, disease severity, coronary anatomy, timing from myocardial infarction to shock onset, and the prognostic effect of revascularization between groups.
- Patients with right ventricular shock were younger, had lower rates of prior myocardial infarction (25.5% vs. 40.1%, p = 0.047), less multivessel disease (34.8% vs. 77.8%, p < 0.001), and shorter median time from index infarction to shock diagnosis (2.9 vs. 6.2 hours, p = 0.003).
- In-hospital mortality was 53.1% for right ventricular shock compared to 60.8% for left ventricular shock (p = 0.296), with revascularization showing a similar survival benefit in both groups.
- Multivariate analysis demonstrated that right ventricular shock was not an independent predictor of reduced in-hospital mortality (odds ratio 1.07, 95% confidence interval 0.54 to 2.13).
Study Design
Type
Cohort (n=933)
PICO
P
Population
933 patients with acute myocardial infarction complicated by cardiogenic shock due to predominant right ventricular or left ventricular failure from the SHOCK trial registry.
E
Exposure / Comparator
Predominant right ventricular (RV) shock vs Left ventricular (LV) shock
O
Primary Outcome
In-hospital mortality — OR 1.07 (0.54 to 2.13), p=0.296
Main Result
Odds Ratio: 1.07 (95% CI 0.54–2.13)
Absolute Event Rate: 53.1% vs 60.8%
p-value: p=0.296
Cite This Study
Jacobs et al. (2003) conducted a cohort in Acute myocardial infarction complicated by cardiogenic shock (n=933). Predominant right ventricular (RV) shock vs. Left ventricular (LV) shock was evaluated on In-hospital mortality (OR 1.07, 95% CI 0.54 to 2.13, p=0.296). Predominant right ventricular shock was associated with similar in-hospital mortality compared to left ventricular shock (53.1% vs 60.8%, P=0.296; adjusted OR 1.07, 95% CI 0.54-2.13).