title: Cardiogenic shock in patients with acute ischemic syndromes with and without ST-segment elevation.
abstract: BACKGROUND
  Cardiogenic shock is usually considered a sequela of ST-segment elevation myocardial infarction. There are limited prospective data on the incidence and significance of shock in non-ST-segment elevation patients. This study assessed the incidence and outcomes of cardiogenic shock developing after enrollment among patients with and without ST-segment elevation in the Global Use of Strategies To Open Occluded Coronary Arteries (GUSTO)-IIb trial.
  
  
  RESULTS
  Among 12,084 patients in GUSTO-IIb who did not present with cardiogenic shock, 4092 (34%) had and 7991 (66%) did not have ST-segment elevation on the enrollment ECG. Cardiogenic shock developed in 4.2% of ST-segment elevation patients compared with 2.5% of patients without ST-segment elevation (odds ratio, 0. 581; 95% CI, 0.472 to 0.715; P<0.001). Shock developed significantly later among patients without ST-segment elevation. There were significant differences in baseline characteristics between shock patients with and without ST-segment elevation: Patients without ST-segment elevation were older, more frequently had diabetes mellitus and 3-vessel disease, but had less TIMI grade 0 flow at angiography. Regardless of the initial ECG, mortality was high: 63% among patients with ST-segment elevation and 73% in those without ST-segment elevation.
  
  
  CONCLUSIONS
  Cardiogenic shock occurs in the setting of acute ischemic syndromes regardless of whether ST-segment elevation is present. The incidence, patient characteristics, timing, clinical course, and angiographic findings differ between the 2 groups. Mortality from cardiogenic shock is similarly high among patients with and without ST-segment elevation.
authors.affiliation: Mayo Clinic and Foundation, Rochester, MN 55905, USA. dholmes@mayo.edu
authors.forename: D R
authors.initials: DR
authors.lastname: Holmes
authors.forename: P B
authors.initials: PB
authors.lastname: Berger
authors.forename: J S
authors.initials: JS
authors.lastname: Hochman
authors.forename: C B
authors.initials: CB
authors.lastname: Granger
authors.forename: T D
authors.initials: TD
authors.lastname: Thompson
authors.forename: R M
authors.initials: RM
authors.lastname: Califf
authors.forename: A
authors.initials: A
authors.lastname: Vahanian
authors.forename: E R
authors.initials: ER
authors.lastname: Bates
authors.forename: E J
authors.initials: EJ
authors.lastname: Topol
mesh_terms: D000368:Aged; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D009203:Myocardial Infarction / Q000150:complications* / Q000503:physiopathology; D012770:Shock, Cardiogenic / Q000209:etiology*