title: Implications of the timing of onset of cardiogenic shock after acute myocardial infarction: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK?
abstract: OBJECTIVE
  We sought to examine the implications of the timing of onset of cardiogenic shock (CS) after acute myocardial infarction (MI).
  
  
  BACKGROUND
  Little information is available about the relationships between timing, clinical substrate, management and outcomes of shock.
  
  
  METHODS
  The multinational SHOCK Trial Registry enrolled MI patients with CS from 1993 to 1997. Cardiogenic shock was predominantly attributable to left ventricular (LV) failure in 815 Registry patients for whom temporal data were available. We examined factors related to the timing of shock onset and the relation of temporal onset to in-hospital outcomes.
  
  
  RESULTS
  Overall, shock developed a median of 6.2 h after MI symptom onset. Shock onset varied by culprit artery: left main, median 1.7 h; right, 3.5 h; circumflex, 3.9 h; left anterior descending (LAD), 11.0 h; saphenous vein graft, 10.9 h (p = 0.025). Early shock (< 24 h) occurred in 74.1% and was associated with chest pain at shock onset, ST-segment elevation in two or more leads, multiple infarct locations, inferior MI, left main disease and smoking. Late shock (> or = 24 h) was associated with recurrent ischemia, Q waves in two or more leads and LAD culprit vessel. Mortality was higher in patients with early versus late shock (62.6% vs. 53.6%, p = 0.022).
  
  
  CONCLUSIONS
  Shock onset after acute MI occurred within 24 h in 74% of the patients with predominant LV failure. Mortality was slightly higher in patients developing shock early rather than later. Many factors influence when shock develops, which has implications for its management.
authors.affiliation: St. Paul's Hospital, Vancouver, British Columbia, Canada. webb@providencehealth.bc.ca
authors.forename: J G
authors.initials: JG
authors.lastname: Webb
authors.forename: L A
authors.initials: LA
authors.lastname: Sleeper
authors.forename: C E
authors.initials: CE
authors.lastname: Buller
authors.forename: J
authors.initials: J
authors.lastname: Boland
authors.forename: A
authors.initials: A
authors.lastname: Palazzo
authors.forename: E
authors.initials: E
authors.lastname: Buller
authors.forename: H D
authors.initials: HD
authors.lastname: White
authors.forename: J S
authors.initials: JS
authors.lastname: Hochman
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000453:epidemiology / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D009204:Myocardial Revascularization; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries / Q000706:statistics & numerical data; D012770:Shock, Cardiogenic / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D015996:Survival Rate; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000453:epidemiology / Q000601:surgery