Predictors of 30-day mortality in patients with refractory cardiogenic shock following acute myocardial infarction despite a patent infarct artery.
BACKGROUND
Little is known about predictors of survival in patients with persistent shock following acute myocardial infarction (MI) despite a patent infarct artery.


METHODS
We examined data from TRIUMPH, a multicenter randomized clinical trial of the nitric oxide synthase inhibitor, L-N(G)-monomethyl-arginine, in patients with persistent vasopressor-dependent cardiogenic shock complicating acute MI at least 1 hour after established infarct-related artery patency. Patients who died within 30 days were compared with those who survived. Continuous variables were assessed using the Wilcoxon rank sum and categorical variables using the chi(2) test. Prespecified baseline variables were included in a multivariable logistic regression model to predict mortality. A second model incorporating baseline vasopressors and dosages and a third model including change in systolic blood pressure at 2 hours were also developed. Bootstrapping was used to assess the stability of model variables.


RESULTS
Of 396 patients, 180 (45.5%) died within 30 days. Systolic blood pressure (SBP), measured on vasopressor support, and creatinine clearance were significant predictors of mortality in all models. The number of vasopressors and norepinephrine dose were also predictors of mortality in the second model, but the latter was no longer significant when change in SBP at 2 hours was added as a covariate in the third model.


CONCLUSIONS
The SBP, creatinine clearance, and number of vasopressors are significant predictors of mortality in patients with persistent vasopressor-dependent cardiogenic shock following acute MI despite a patent infarct artery. These prognostic variables may be useful for risk-stratification and in selecting patients for investigation of additional therapies.
Katz
Jason N
JN
University of North Carolina School of Medicine, Chapel Hill, NC 27599-7875, USA. Jason_Katz@med.unc.edu
Stebbins
Amanda L
AL
Alexander
John H
JH
Reynolds
Harmony R
HR
Pieper
Karen S
KS
Ruzyllo
Witold
W
Werdan
Karl
K
Geppert
Alexander
A
Dzavik
Vladimir
V
Van de Werf
Frans
F
Hochman
Judith S
JS
D000368:Aged; D001120:Arginine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D003331:Coronary Vessels / Q000503:physiopathology*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D019001:Nitric Oxide Synthase / Q000037:antagonists & inhibitors; D009638:Norepinephrine / Q000008:administration & dosage*; D009864:Ontario / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014654:Vascular Patency / Q000502:physiology*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D019323:omega-N-Methylarginine
D001120:Arginine; D019001:Nitric Oxide Synthase; D009638:Norepinephrine; D014662:Vasoconstrictor Agents; C092506:N(G)-monomethylarginine acetate; D019323:omega-N-Methylarginine