title: An early revascularization strategy is associated with a survival benefit for diabetic patients in cardiogenic shock after acute myocardial infarction.
abstract: BACKGROUND
  The role of diabetes mellitus (DM) in cardiogenic shock (CS) complicating an acute myocardial infarction (AMI) is not well understood. Previous studies have reported an in-hospital mortality rate for patients with DM and CS of about 60%.
  
  
  OBJECTIVE
  This study compares the 1-year mortality rates of patients with DM and those without (NDM) and evaluates early revascularization (ERV) compared with initial medical stabilization (IMS) in patients with DM and CS.
  
  
  METHODS
  Baseline characteristics, clinical and hemodynamic measures, and management were compared for 90 patients (31%) with DM and 198 with NDM (69%) who were randomized to ERV or IMS in the SHOCK Trial.
  
  
  RESULTS
  When compared with NDM, patients with DM were of similar age but had higher rates of prior MI (44.4 vs. 27.8%, p = 0.007) and hypertension (56.2 vs. 42.5%, p = 0.04). The DM group had a lower rate of fibrinolytic therapy (44.4 vs. 60.1%, p = 0.02). In patients randomized to ERV, patients with DM had a higher rate of coronary artery bypass grafting (CABG) (50.0 vs. 30.9%, p = 0.03) despite similar rates of triple-vessel disease. The 1-year mortality rates in both groups were equivalent (58.9%). One-year mortality was not associated with diabetes (hazard ratio [HR] 1.02, 95% CI, 0.73-1.42, p = 0.91). The benefit of an ERV strategy was similar (HR [DM] 0.62; HR [NDM] 0.75, p = 0.58). Even after adjusting for the imbalance in CABG rates, 1-year mortality was not associated with DM.
  
  
  CONCLUSIONS
  Diabetes mellitus is not a predictor of 1-year mortality in CS after AMI. The benefit from an ERV strategy is similar for DM and NDM. The management strategies and influence of DM on mortality in CS deserve further evaluation.
authors.affiliation: Cardiovascular Institute, Mount Sinai School of Medicine, Mount Sinai Medical Center, New York, New York 10029, USA. michael.farkouh@mssm.edu
authors.forename: Michael E
authors.initials: ME
authors.lastname: Farkouh
authors.forename: Krishnan
authors.initials: K
authors.lastname: Ramanathan
authors.forename: Eve D
authors.initials: ED
authors.lastname: Aymong
authors.forename: John G
authors.initials: JG
authors.lastname: Webb
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Harkness
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Sleeper
authors.forename: Judith S
authors.initials: JS
authors.lastname: Hochman
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000601:surgery*; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome