Emergency revascularization in patients with cardiogenic shock on admission: a report from the SHOCK trial and registry.
OBJECTIVE
To determine clinical correlates and optimal treatment strategy in patients with cardiogenic shock (CS) on admission.


RESULTS
In SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK? (SHOCK) trial and registry patients with left ventricular (LV) dysfunction (n=1053), CS on admission occurred in 26% of directly admitted patients (n=166/627). Time from myocardial infarction to CS was shorter, initial haemodynamic profile poorer, and aggressive treatment less frequent in CS on admission than in delayed CS patients. CS on admission patients constituted a smaller relative proportion (11%) of the transferred (n=48/426) when compared with the directly admitted cohort (P<0.001). In-hospital mortality was higher (75 vs. 56%; P<0.001) with more rapid death (24-h mortality 40 vs. 17%; P<0.001) in CS on admission than in delayed CS patients. Emergency revascularization reduced in-hospital mortality in CS on admission (60 vs. 82%; P=0.001) and in delayed CS patients similarly (46 vs. 62%; P<0.001; interaction P=0.25). After adjustment for clinical differences, CS on admission was an independent predictor of in-hospital mortality (P=0.008).


CONCLUSIONS
CS on admission patients have a worse outcome but benefit equally from emergency revascularization as delayed CS patients, emphasizing the need for rapid and direct access of CS on admission patients to facilities providing this care.
Jeger
Raban V
RV
Cardiovascular Clinical Research Center, New York University School of Medicine, 530 First Avenue, HCC 1173, New York, NY 10016, USA.
Harkness
Shannon M
SM
Ramanathan
Krishnan
K
Buller
Christopher E
CE
Pfisterer
Matthias E
ME
Sleeper
Lynn A
LA
Hochman
Judith S
JS
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015331:Cohort Studies; D004630:Emergencies; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000401:mortality / Q000706:statistics & numerical data*; D012042:Registries; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000401:mortality / Q000601:surgery*