title: Hemodynamic parameters are prognostically important in cardiogenic shock but similar following early revascularization or initial medical stabilization: a report from the SHOCK Trial.
abstract: BACKGROUND
  In cardiogenic shock (CS), conclusive data on serial hemodynamic measurements for treatment guidance and prognosis are lacking.
  
  
  METHODS
  The SHOCK (Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock?) Trial tested early revascularization (ERV) vs initial medical stabilization (IMS) in CS complicating acute myocardial infarction and serially assessed hemodynamics by pulmonary artery catheter.
  
  
  RESULTS
  Data were available in 278 patients (95%) surviving to the first measurement with predominant left ventricular failure at baseline and in 174 patients (70%) at follow-up. Baseline and follow-up hemodynamic data were similar in the treatment groups. The median time from CS to baseline measurements was 3.3 h in both treatment groups, whereas follow-up measurements were obtained earlier in the IMS group (median time, 10.6 h) than in the ERV group (median time, 12.5 h; p = 0.043). At baseline, stroke volume index (SVI) was an independent predictor of 30-day mortality after adjustment for age (odds ratio, 0.69 per 5 mL/m2 increase; 95% confidence interval, 0.55 to 0.87; p = 0.002). At follow-up, both stroke work index (SWI) [odds ratio, 0.54 per 5 g/m/m2 increase; 95% confidence interval, 0.39 to 0.76; p < 0.001] and SVI (odds ratio, 0.59 per 5 mL/m2 increase; 95% confidence interval, 0.45 to 0.77; p < 0.001) were similarly powerful predictors of 30-day mortality after adjustment for age.
  
  
  CONCLUSIONS
  SVI and SWI are the most powerful hemodynamic predictors of 30-day mortality in CS patients. Hemodynamic parameters are similar for surviving patients following ERV and IMS. Thus, early hemodynamic stability after IMS should not delay revascularization since long-term outcomes are superior with ERV.
authors.affiliation: Cardiovascular Clinical Research Center, New York University School of Medicine, New York, NY, USA. rjeger@uhbs.ch
authors.forename: Raban V
authors.initials: RV
authors.lastname: Jeger
authors.forename: April M
authors.initials: AM
authors.lastname: Lowe
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Buller
authors.forename: Matthias E
authors.initials: ME
authors.lastname: Pfisterer
authors.forename: Vladimir
authors.initials: V
authors.lastname: Dzavik
authors.forename: John G
authors.initials: JG
authors.lastname: Webb
authors.forename: Judith S
authors.initials: JS
authors.lastname: Hochman
authors.forename: Ulrich P
authors.initials: UP
authors.lastname: Jorde
mesh_terms: D000368:Aged; D005260:Female; D006439:Hemodynamics; D006801:Humans; D016015:Logistic Models; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D009204:Myocardial Revascularization; D011379:Prognosis; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D016896:Treatment Outcome