title: Predictors of mortality in patients with acute myocardial infarction and cardiogenic shock.
abstract: BACKGROUND
  Although cardiogenic shock (CS) is the leading cause of death for acute myocardial infarction (AMI) patients, reliable predictive factors in the acute stage, such as cardiovascular peptides, have not yet been identified.
  
  
  RESULTS
  In 42 consecutive AMI patients with CS on admission, successfully treated by primary percutaneous coronary intervention (PCI) within 12 h of onset, related factors including brain natriuretic peptide (BNP), atrial natriuretic peptide (ANP), renin, aldosterone, catecholamines, and adrenomedullin, were investigated 24 h from onset, as well as the 1-year mortality rates. During the 12-month follow-up period, 15 patients died from cardiovascular causes (group D). There were no significant differences in patient characteristics, angiographic findings, and left ventricular systolic function between group D subjects and the survivors (group S: n=27). Multivariate analysis identified high levels of adrenomedullin as an independent predictor of 1-year mortality (risk ratio: 6.42, 95% confidence interval, 1.49-43.31, p<0.05).
  
  
  CONCLUSIONS
  The acute-phase plasma concentration of adrenomedullin may be a reliable predictor of mortality in patients with AMI complicated by CS and successfully treated by direct PCI, as may be BNP concentration, peak-creatine kinase value, and ventricular fibrillation.
authors.affiliation: Department of Cardiovascular Medicine, Course of Medical and Dental Sciences, Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, Nagasaki, Japan. snowman-kt@syd.odn.ne.jp
authors.forename: Toshiro
authors.initials: T
authors.lastname: Katayama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakashima
authors.forename: Chisa
authors.initials: C
authors.lastname: Takagi
authors.forename: Yukiharu
authors.initials: Y
authors.lastname: Honda
authors.forename: Shin
authors.initials: S
authors.lastname: Suzuki
authors.forename: Katsusuke
authors.initials: K
authors.lastname: Yano
mesh_terms: D000800:Angioplasty, Balloon; D001241:Aspirin / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000032:analysis; D002784:Cholesterol / Q000097:blood; D004562:Electrocardiography; D006728:Hormones / Q000097:blood; D006801:Humans; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications / Q000401:mortality* / Q000628:therapy; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000097:blood / Q000150:complications / Q000401:mortality* / Q000628:therapy; D013988:Ticlopidine / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D006728:Hormones; D010975:Platelet Aggregation Inhibitors; D002097:C-Reactive Protein; D002784:Cholesterol; D013988:Ticlopidine; D001241:Aspirin