Diabetes mellitus in cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK?
OBJECTIVE
We sought to examine the role of diabetes mellitus in cardiogenic shock (CS) complicating acute myocardial infarction (AMI) in the SHOCK Trial Registry.


BACKGROUND
The characteristics, outcomes and optimal treatment of diabetic patients with CS complicating AMI have not been well described.


METHODS
Baseline characteristics, clinical and hemodynamic measures, treatment variables, shock etiologies and comorbid conditions were compared for 379 diabetic and 784 nondiabetic patients. Logistic regression was used to examine the association between diabetes and in-hospital mortality, after adjustment for baseline differences.


RESULTS
Diabetics were less likely than nondiabetics to undergo thrombolysis (28% vs. 37%; p = 0.002) or attempted revascularization (40% vs. 49%; p = 0.008). The survival benefit for diabetics selected for percutaneous or surgical revascularization (55% vs. 19% without revascularization) was similar to that for nondiabetics (59% vs. 25%). Overall unadjusted in-hospital mortality was significantly higher for diabetics (67% vs. 58%; p = 0.007), but diabetes was only a borderline predictor of mortality after adjustment for baseline and treatment differences (odds ratio for death, 1.36; 95% confidence interval, 1.00 to 1.84; p = 0.051).


CONCLUSIONS
Diabetics with CS complicating AMI have a higher-risk profile at baseline, but after adjustment, diabetics have an in-hospital survival rate that is only marginally lower than that of nondiabetics. Diabetics who undergo revascularization derive a survival benefit similar to that of nondiabetics.
Shindler
D M
DM
UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA. shindler@umdnj.edu
Palmeri
S T
ST
Antonelli
T A
TA
Sleeper
L A
LA
Boland
J
J
Cocke
T P
TP
Hochman
J S
JS
D000368:Aged; D017023:Coronary Angiography; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D009204:Myocardial Revascularization; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012770:Shock, Cardiogenic / Q000150:complications* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D015912:Thrombolytic Therapy