title: Angiographic findings and clinical correlates in patients with cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK?
abstract: OBJECTIVE
  We sought to delineate the angiographic findings, clinical correlates and in-hospital outcomes in patients with cardiogenic shock (CS) complicating acute myocardial infarction.
  
  
  BACKGROUND
  Patients with CS complicating acute myocardial infarction carry a grave prognosis. Detailed angiographic findings in a large, prospectively identified cohort of patients with CS are currently lacking.
  
  
  METHODS
  We compared the clinical characteristics, angiographic findings, and in-hospital outcomes of 717 patients selected to undergo angiography and 442 not selected, overall and by shock etiology: left or right ventricular failure versus mechanical complications.
  
  
  RESULTS
  Patients who underwent angiography had lower baseline risk and a better hemodynamic profile than those who did not. Overall, 15.5% of the patients had significant left main lesions on angiography, and 53.4% had three-vessel disease, with higher rates of both for those with ventricular failure, compared with patients who had mechanical complications. Among patients who underwent angiography, those with ventricular failure had significantly lower in-hospital mortality than patients with mechanical complications (45.2% vs. 57.0%; p = 0.021). Importantly, for patients with ventricular failure, in-hospital mortality also correlated with disease severity: 35.0% for no or single-vessel disease versus 50.8% for three-vessel disease. Furthermore, mortality was associated with the culprit lesion location (78.6% in left main lesion, 69.7% in saphenous vein graft lesions, 42.4% in circumflex lesions, 42.3% in left anterior descending lesions, and 37.4% in right coronary artery lesions), and Thrombolysis In Myocardial Infarction (TIMI) flow grade (46.5% in TIMI 0/1, 49.4% in TIMI 2 and 26% in TIMI 3).
  
  
  CONCLUSIONS
  Patients who underwent angiographic study in the SHOCK Trial Registry had a more benign cardiac risk profile, more favorable hemodynamic findings and lower in-hospital mortality than those for whom angiograms were not obtained. Patients with CS caused by ventricular failure had more severe atherosclerosis, and a different distribution of culprit vessel involvement but lower in-hospital mortality, than those with mechanical complications. Overall in-hospital survival correlates with the extent of coronary artery obstructions, location of culprit lesion and baseline coronary TIMI flow grade.
authors.affiliation: Department of Internal Medicine, the New York Hospital-Cornell Medical Center, New York, USA. scwong@med.cornell.edu
authors.forename: S C
authors.initials: SC
authors.lastname: Wong
authors.forename: T
authors.initials: T
authors.lastname: Sanborn
authors.forename: L A
authors.initials: LA
authors.lastname: Sleeper
authors.forename: J G
authors.initials: JG
authors.lastname: Webb
authors.forename: R
authors.initials: R
authors.lastname: Pilchik
authors.forename: D
authors.initials: D
authors.lastname: Hart
authors.forename: S
authors.initials: S
authors.lastname: Mejnartowicz
authors.forename: T A
authors.initials: TA
authors.lastname: Antonelli
authors.forename: R
authors.initials: R
authors.lastname: Lange
authors.forename: J K
authors.initials: JK
authors.lastname: French
authors.forename: G
authors.initials: G
authors.lastname: Bergman
authors.forename: T
authors.initials: T
authors.lastname: LeJemtel
authors.forename: J S
authors.initials: JS
authors.lastname: Hochman
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity; D017023:Coronary Angiography; D003326:Coronary Circulation; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D009204:Myocardial Revascularization; D011446:Prospective Studies; D012042:Registries; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D015912:Thrombolytic Therapy; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy