title: The ability to achieve complete revascularization is associated with improved in-hospital survival in cardiogenic shock due to myocardial infarction: Manitoba cardiogenic SHOCK Registry investigators.
abstract: OBJECTIVE
  To identify predictors of survival in a retrospective multicentre cohort of patients with cardiogenic shock undergoing coronary angiography and to address whether complete revascularization is associated with improved survival in this cohort.
  
  
  BACKGROUND
  Early revascularization is the standard of care for cardiogenic shock. Coronary bypass grafting and percutaneous intervention have complimentary roles in achieving this revascularization.
  
  
  METHODS
  A total of 210 consecutive patients (mean age 66 ± 12 years) at two tertiary centres from 2002 to 2006 inclusive with a diagnosis of cardiogenic shock were evaluated. Univariate and multivariate predictors of in-hospital survival were identified utilizing logistic regression.
  
  
  RESULTS
  ST elevation infarction occurred in 67% of patients. Thrombolysis was administered in 34%, PCI was attempted in 62% (88% stented, 76% TIMI 3 flow), CABG was performed in 22% (2.7 grafts, 14 valve procedures), and medical therapy alone was administered to the remainder. The overall survival to discharge was 59% (CABG 68%, PCI 57%, medical 48%). Independent predictors of mortality included complete revascularization (P = 0.013, OR = 0.26 (95% CI: 0.09-0.76), hyperlactatemia (P = 0.046, OR = 1.14 (95% CI: 1.002-1.3) per mmol increase), baseline renal insufficiency (P = 0.043, OR = 3.45, (95% CI: 1.04-11.4), and the presence of anoxic brain injury (P = 0.008, OR = 8.22 (95% CI: 1.73-39.1). Within the STEMI with concomitant multivessel coronary disease subgroup of this population (N = 101), independent predictors of survival to discharge included complete revascularization (P = 0.03, OR = 2.5 (95% CI: 1.1-6.2)) and peak lactate (P = 0.02).
  
  
  CONCLUSIONS
  The ability to achieve complete revascularization may be strongly associated with improved in-hospital survival in patients with cardiogenic shock.
authors.affiliation: Section of Cardiology Dept. of Cardiac Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. fhussain@sbgh.mb.ca
authors.forename: Farrukh
authors.initials: F
authors.lastname: Hussain
authors.forename: Roger K
authors.initials: RK
authors.lastname: Philipp
authors.forename: Robin A
authors.initials: RA
authors.lastname: Ducas
authors.forename: Jason
authors.initials: J
authors.lastname: Elliott
authors.forename: Vladimír
authors.initials: V
authors.lastname: Džavík
authors.forename: Davinder S
authors.initials: DS
authors.lastname: Jassal
authors.forename: James W
authors.initials: JW
authors.lastname: Tam
authors.forename: Daniel
authors.initials: D
authors.lastname: Roberts
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Garber
authors.forename: John
authors.initials: J
authors.lastname: Ducas
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality*; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002407:Catheterization, Swan-Ganz; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008350:Manitoba; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D016017:Odds Ratio; D010351:Patient Discharge / Q000706:statistics & numerical data; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents