Cardiogenic shock developing in the coronary care unit in patients with ST-elevation myocardial infarction.
BACKGROUND
A relevant proportion of patients with ST-segment elevation myocardial infarction may develop cardiogenic shock after presentation, and the identification of these patients would be very important in order to improve their outcome. The aim of the current study was to identify, among patients in the BLITZ-1, the clinical predictors, and describe the outcome of patients who developed cardiogenic shock during hospitalization.


METHODS
The study was a nationwide survey of patients admitted to a coronary care units for an acute myocardial infarction with or without ST-segment elevation myocardial infarction in October 2001. The 30-day follow-up was conducted by hospital visits and concerned major cardiac events occurred from hospital discharge.


RESULTS
A total of 1345 patients presenting with ST-segment elevation myocardial infarction or left bundle branch block/pacemaker were included in this analysis. A total of 97 patients (7.2%) had cardiogenic shock, 26 patients at presentation, whereas 71 patients (73.2%) developed shock during hospital stay. Mortality was 71.8% among patients who developed cardiogenic shock during hospitalization as compared with 65.4% among those who were already in shock upon admission (P = 0.54). By multivariable analysis, we identified Killip class more than 1, lower systolic blood pressure at presentation, older age, unsuccessful reperfusion and diabetes as independent predictors of developing shock during hospitalization.


CONCLUSIONS
The present study shows that the largest proportion of cardiogenic shock complicating ST-segment elevation myocardial infarction is observed after initial hospitalization, particularly in patients with Killip class more than 1, low systolic blood pressure at presentation and advanced age. The identification of these patients may help in preventing this complication by more aggressive pharmacological therapies, mechanical haemodynamic support, as well as coronary revascularization.
De Luca
Giuseppe
G
Division of Cardiology, 'Maggiore della Carità' Hospital, Eastern Piedmont University 'A. Avogadro', and Centro di Biotecnologie per la Ricerca Medica Applicata (BRMA), Novara, Italy. giuseppe.deluca@med.unipmn.it
Savonitto
Stefano
S
Greco
Cesare
C
Parodi
Guido
G
Dajelli Ermolli
Nevio C
NC
Silva
Caterina
C
Lucci
Donata
D
Gonzini
Lucio
L
Maggioni
Aldo P
AP
Cuccia
Claudio
C
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D003325:Coronary Care Units; D048909:Diabetes Complications / Q000209:etiology; D005260:Female; D019538:Health Care Surveys; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000150:complications; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D015425:Myocardial Reperfusion / Q000009:adverse effects; D012307:Risk Factors; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D013997:Time Factors; D017211:Treatment Failure