The in-hospital development of cardiogenic shock after myocardial infarction: incidence, predictors of occurrence, outcome and prognostic factors. The MILIS Study Group.
The incidence, outcome and predictors of the in-hospital development of cardiogenic shock and its prognostic significance were analyzed in 845 patients presenting with acute myocardial infarction. Cardiogenic shock developed after hospitalization in 60 patients (7.1%). In half of these patients, cardiogenic shock developed at least 24 h after hospital admission. The in-hospital mortality rate was greater than 15 times higher for patients with cardiogenic shock than for patients without shock (65.0% versus 4.3%, respectively, p less than 0.001). Enzymatic evidence of infarct extension occurred in 23.3% of the patients with shock compared with 7.4% of those without shock (p less than 0.0001). Multivariate analysis indicated that independent predictors for the in-hospital development of cardiogenic shock were age greater than 65 years (p = 0.007), left ventricular ejection fraction on hospital admission less than 35% (p = 0.007), large infarct as estimated from serial enzyme determinations (that is, peak creatine kinase-MB isoenzyme greater than 160 IU/liter (p = 0.008), history of diabetes mellitus (p = 0.011) and previous myocardial infarction (p = 0.012). Patients with three, four or five of these risk factors had a 17.9%, 33.7% or 54.4% probability, respectively, of developing cardiogenic shock after hospital admission. Left ventricular function, as reflected by left ventricular ejection fraction (p = 0.04) and severity of left ventricular wall motion abnormality (p = 0.04), was the most important determinant of in-hospital mortality in the patients with cardiogenic shock.
Hands
M E
ME
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115.
Rutherford
J D
JD
Muller
J E
JE
Davies
G
G
Stone
P H
PH
Parker
C
C
Braunwald
E
E
D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology; D003402:Creatine Kinase / Q000378:metabolism; D004562:Electrocardiography; D006439:Hemodynamics; D006760:Hospitalization; D006801:Humans; D007527:Isoenzymes; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000503:physiopathology; D011379:Prognosis; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D013318:Stroke Volume
D007527:Isoenzymes; D003402:Creatine Kinase