title: Characteristics and clinical outcomes of patients with cardiogenic shock complicating acute myocardial infarction treated by emergent coronary angioplasty.
abstract: BACKGROUND
  Cardiogenic shock (CS) is a dreadful complication of acute myocardial infarction (AMI) associated with a poor prognosis. Percutaneous coronary intervention (PCI) is widely recommended by current treatment guidelines.
  
  
  OBJECTIVE
  To evaluate the in-hospital and 30-day mortality rate and to determine independent predictors of mortality in a cohort of unselected consecutive patients with CS.
  
  
  RESULTS
  Rabin Medical Center cardiac catheterization laboratory database was analyzed between 1/2000 and 8/2003. Fifty of the 472 patients (10.6%) treated using emergent PCI for AMI had cardiogenic shock on presentation. Patients with cardiogenic shock were older, more likely to be female and with higher frequency of co-morbidities. The time from symptom onset until seeking medical treatment was longer in cardiogenic shock patients. In-hospital mortality rate was 48.0% in the cardiogenic shock group as compared to 3.3% in the non-cardiogenic shock group (P<0.0001). In patients with shock, total mortality after 30 days was 52% (26/50). Most of these patients (25/26) died within 48 hours following admission because of refractory cardiogenic shock. A multivariate analysis adjusted for baseline differences showed that age 75 years (odds ratio [OR]: 11; 95% confidence interval [CI]: 1.0-1.24, P=0.05), and the use of GP 2b/3a antagonist (OR: 0.97; 95% CI: 0.95-1.0, P=0.05), were independent predictors of all cause mortality at 30 days.
  
  
  CONCLUSIONS
  Cardiogenic shock remains an important cause of mortality in AMI. Younger age and the use of GP 2b/3a antagonists during primary PCI for cardiogenic shock patients seems to be associated with better clinical outcomes.
authors.affiliation: Cardiac Catheterization Laboratories, Department of Cardiology, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Abid R
authors.initials: AR
authors.lastname: Assali
authors.forename: Zaza
authors.initials: Z
authors.lastname: Iakobishvili
authors.forename: Nili
authors.initials: N
authors.lastname: Zafrir
authors.forename: Alejandro
authors.initials: A
authors.lastname: Solodky
authors.forename: Igal
authors.initials: I
authors.lastname: Teplitsky
authors.forename: Eldad
authors.initials: E
authors.lastname: Rechavia
authors.forename: Nader
authors.initials: N
authors.lastname: Butto
authors.forename: Nurit
authors.initials: N
authors.lastname: Shor
authors.forename: David
authors.initials: D
authors.lastname: Hasdai
authors.forename: Shmuel
authors.initials: S
authors.lastname: Fuchs
authors.forename: Alexander
authors.initials: A
authors.lastname: Battler
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowski
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome