title: Percutaneous coronary intervention for cardiogenic shock in the SHOCK Trial Registry.
abstract: BACKGROUND
  The SHOCK Registry prospectively enrolled patients with cardiogenic shock complicating acute myocardial infarction in 36 multinational centers.
  
  
  METHODS
  Cardiogenic shock was predominantly attributable to left ventricular pump failure in 884 patients. Of these, 276 underwent percutaneous coronary intervention (PCI) after shock onset and are the subject of this report.
  
  
  RESULTS
  The majority (78%) of patients undergoing angiography had multivessel disease. As the number of diseased arteries rose from 1 to 3, mortality rates rose from 34.2% to 51.2%. Patients who underwent PCI had lower in-hospital mortality rates than did patients treated medically (46.4% vs 78.0%, P < .001), even after adjustment for patient differences and survival bias (P = .037). Before PCI, the culprit artery was occluded (Thrombolysis In Myocardial Infarction grade 0 or 1 flow) in 76.3%. After PCI, the in-hospital mortality rate was 33.3% if reperfusion was complete (grade 3 flow), 50.0% with incomplete reperfusion (grade 2 flow), and 85.7% with absent reperfusion (grade 0 or 1 flow) (P < .001).
  
  
  CONCLUSIONS
  This prospective, multicenter registry of patients with acute myocardial infarction complicated by cardiogenic shock is consistent with a reduction in mortality rates as the result of percutaneous coronary revascularization. Coronary artery patency was an important predictor of outcome. Measures to promote early and rapid reperfusion appear critically important in improving the otherwise poor outcome associated with cardiogenic shock.
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: T A
authors.initials: TA
authors.lastname: Sanborn
authors.forename: L A
authors.initials: LA
authors.lastname: Sleeper
authors.forename: R G
authors.initials: RG
authors.lastname: Carere
authors.forename: C E
authors.initials: CE
authors.lastname: Buller
authors.forename: J N
authors.initials: JN
authors.lastname: Slater
authors.forename: K W
authors.initials: KW
authors.lastname: Baran
authors.forename: P T
authors.initials: PT
authors.lastname: Koller
authors.forename: J D
authors.initials: JD
authors.lastname: Talley
authors.forename: M
authors.initials: M
authors.lastname: Porway
authors.forename: J S
authors.initials: JS
authors.lastname: Hochman
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002170:Canada / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy; D011446:Prospective Studies; D012042:Registries; D012770:Shock, Cardiogenic / Q000401:mortality* / Q000628:therapy*; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology