Key result
Absence of pulmonary congestion at initial evaluation in cardiogenic shock is not associated with lower in-hospital mortality compared to congestion with hypoperfusion (70% vs 60%; adjusted P=0.153).
Why the study?
The prevalence of pulmonary congestion in patients with suspected cardiogenic shock due to predominant left ventricular failure was uncertain.
Observational (n=571)
The absence of pulmonary congestion at initial clinical evaluation does not exclude a diagnosis of cardiogenic shock due to predominant left ventricular failure and is not associated with a better prognosis.
OBJECTIVES: We sought to evaluate the frequency of pulmonary congestion and associated clinical and hemodynamic findings in patients with suspected cardiogenic shock (CS). BACKGROUND: The prevalence of pulmonary congestion in the setting of CS is uncertain. METHODS: The 571 SHOCK Trial Registry patients with predominant left ventricular failure (LVF) were divided into four groups: Group A = no pulmonary congestion/no hypoperfusion = 14 (3%), Group B = isolated pulmonary congestion = 32 (6%), Group C = isolated hypoperfusion = 158 (28%) and Group D = congestion with hypoperfusion = 367 (64%). Statistical comparisons between Group C and D only, with regard to patient demographics, hemodynamics, treatment and outcome, were made. RESULTS: A significant proportion of patients with shock had no pulmonary congestion (Group C = 28%, 95% CI, 24% to 31%). Age and gender in this group were similar to Group D. Group C patients were less likely to have a prior MI (p = 0.028), congestive heart failure (p = 0.005) and renal insufficiency (p = 0.032), and the index MI was less likely to be anterior (p = 0.044). Cardiac output, cardiac index and ejection fraction were similar for the two groups but pulmonary capillary wedge pressure was slightly lower for Group C (22 vs. 24 mm Hg, p = 0.012). Treatment with thrombolysis, angioplasty and bypass surgery was similar in the two groups. In-hospital mortality rates for Groups C and D were 70% and 60%, respectively (p = 0.036). After adjustment, this difference was no longer statistically significant (p = 0.153). CONCLUSIONS: Absence of pulmonary congestion at initial clinical evaluation does not exclude a diagnosis of CS due to predominant LVF and is not associated with a better prognosis.
No takes yet. Share an insight, caveat, or question.
Menon et al. (2000) conducted an observational in Suspected cardiogenic shock due to predominant left ventricular failure (n=571). Absence of pulmonary congestion (isolated hypoperfusion) vs. Congestion with hypoperfusion was evaluated on In-hospital mortality (p=0.153). Absence of pulmonary congestion at initial evaluation in cardiogenic shock is not associated with lower in-hospital mortality compared to congestion with hypoperfusion (70% vs 60%; adjusted P=0.153).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: