We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
One-year survival following early revascularization for cardiogenic shock.
- Authors
Hochman, Judith S.; Sleeper, Lynn A.; White, Harvey D.; Dzavik, Vladimir; Wong, S. Chiu; Menon, Venu; Webb, John G.; Steingart, Richard; Picard, Michael H.; Menegus, Mark A.; Boland, Jean; Sanborn, Timothy; Buller, Christopher E.; Modur, Sharada; Forman, Robert; Desvigne-Nickens, Patrice; Jacobs, Alice K.; Slater, James N.; LeJemtel, Thierry H.; Hochman, J S
- Abstract
<bold>Context: </bold>Cardiogenic shock (CS) is the leading cause of death for patients hospitalized with acute myocardial infarction (AMI).<bold>Objective: </bold>To assess the effect of early revascularization (ERV) on 1-year survival for patients with AMI complicated by CS.<bold>Design: </bold>The SHOCK (Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock) Trial, an unblinded, randomized controlled trial from April 1993 through November 1998.<bold>Setting: </bold>Thirty-six referral centers with angioplasty and cardiac surgery facilities.<bold>Patients: </bold>Three hundred two patients with AMI and CS due to predominant left ventricular failure who met specified clinical and hemodynamic criteria.<bold>Interventions: </bold>Patients were randomly assigned to an initial medical stabilization (IMS; n = 150) group, which included thrombolysis (63% of patients), intra-aortic balloon counterpulsation (86%), and subsequent revascularization (25%), or to an ERV group (n = 152), which mandated revascularization within 6 hours of randomization and included angioplasty (55%) and coronary artery bypass graft surgery (38%).<bold>Main Outcome Measures: </bold>All-cause mortality and functional status at 1 year, compared between the ERV and IMS groups.<bold>Results: </bold>One-year survival was 46.7% for patients in the ERV group compared with 33.6% in the IMS group (absolute difference in survival, 13.2%; 95% confidence interval [CI], 2.2%-24.1%; P<.03; relative risk for death, 0.72; 95% CI, 0.54-0.95). Of the 10 prespecified subgroup analyses, only age (<75 vs >/= 75 years) interacted significantly (P<.03) with treatment in that treatment benefit was apparent only for patients younger than 75 years (51.6% survival in ERV group vs 33.3% in IMS group). Eighty-three percent of 1-year survivors (85% of ERV group and 80% of IMS group) were in New York Heart Association class I or II.<bold>Conclusions: </bold>For patients with AMI complicated by CS, ERV resulted in improved 1-year survival. We recommend rapid transfer of patients with AMI complicated by CS, particularly those younger than 75 years, to medical centers capable of providing early angiography and revascularization procedures.
- Subjects
MYOCARDIAL infarction; MYOCARDIAL revascularization; CARDIOGENIC shock; CORONARY disease; PATIENTS
- Publication
JAMA: Journal of the American Medical Association, 2001, Vol 285, Issue 2, p190
- ISSN
0098-7484
- Publication type
journal article
- DOI
10.1001/jama.285.2.190