title: The in-hospital development of cardiogenic shock after myocardial infarction: incidence, predictors of occurrence, outcome and prognostic factors. The MILIS Study Group.
abstract: 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.
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115.
authors.forename: M E
authors.initials: ME
authors.lastname: Hands
authors.forename: J D
authors.initials: JD
authors.lastname: Rutherford
authors.forename: J E
authors.initials: JE
authors.lastname: Muller
authors.forename: G
authors.initials: G
authors.lastname: Davies
authors.forename: P H
authors.initials: PH
authors.lastname: Stone
authors.forename: C
authors.initials: C
authors.lastname: Parker
authors.forename: E
authors.initials: E
authors.lastname: Braunwald
mesh_terms: 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
chemical_list: D007527:Isoenzymes; D003402:Creatine Kinase