Cardiogenic shock caused by right ventricular infarction: a report from the SHOCK registry.
OBJECTIVE
The purpose of this study was to determine the characteristics and outcomes of patients with acute myocardial infarction (MI) complicated by cardiogenic shock due to predominant right ventricular (RV) infarction.


BACKGROUND
Although RV infarction has been shown to have favorable long-term outcomes, the influence of RV infarction on mortality in cardiogenic shock is unknown.


METHODS
We evaluated 933 patients in cardiogenic shock due to predominant RV (n = 49) or left ventricular (LV) failure (n = 884) in the SHould we emergently revascularize Occluded coronaries for Cardiogenic shocK? (SHOCK) trial registry.


RESULTS
Patients with predominant RV shock were younger, with a lower prevalence of previous MI (25.5 vs. 40.1%, p = 0.047), anterior MI, and multivessel disease (34.8 vs. 77.8%, p < 0.001) and a shorter median time between the index MI and the diagnosis of shock (2.9 vs. 6.2 h, p = 0.003) in comparison to patients with LV shock. In-hospital mortality was 53.1% versus 60.8% (p = 0.296) for patients with predominant RV and LV shock, respectively, and the influence of revascularization on mortality was not different between groups. Multivariate analysis revealed that RV shock was not an independent predictor of lower in-hospital mortality (odds ratio 1.07, 95% confidence interval 0.54 to 2.13).


CONCLUSIONS
Despite the younger age, lower rate of anterior MI, and higher prevalence of single-vessel coronary disease of RV compared with LV shock patients, and their similar benefit from revascularization, mortality is unexpectedly high in patients with predominant RV shock and similar to patients with LV shock.
Jacobs
Alice K
AK
Department of Medicine, Boston Medical Center, Massachusetts 02118, USA. alice.jacobs@bmc.org
Leopold
Jane A
JA
Bates
Eric
E
Mendes
Lisa A
LA
Sleeper
Lynn A
LA
White
Harvey
H
Davidoff
Ravin
R
Boland
Jean
J
Modur
Sharada
S
Forman
Robert
R
Hochman
Judith S
JS
D000368:Aged; D017023:Coronary Angiography; D005260:Female; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D012042:Registries; D012770:Shock, Cardiogenic / Q000209:etiology* / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000401:mortality / Q000628:therapy; D018497:Ventricular Dysfunction, Right / Q000150:complications* / Q000401:mortality / Q000628:therapy