title: Rapid complete reversal of systemic hypoperfusion after intra-aortic balloon pump counterpulsation and survival in cardiogenic shock complicating an acute myocardial infarction.
abstract: BACKGROUND
  In patients with cardiogenic shock (CS) complicating an acute myocardial infarction, a strategy of early revascularization (ERV) versus initial medical stabilization (IMS) improves survival. Intra-aortic balloon counterpulsation (IABC) provides hemodynamic support and facilitates coronary angiography and revascularization in CS patients.
  
  
  RESULTS
  We evaluated 499 patients with record of systemic hypoperfusion status as an early response to IABC from the SHOCK trial (n = 185) and registry (n = 314) to determine the association between rapid complete reversal of systemic hypoperfusion (CRH) after 30 minutes of IABC and in-hospital, 30-day and 1-year mortality. Rapid complete reversal of systemic hypoperfusion was highly associated with lower in-hospital mortality (29% versus 65%, P < .001) in all patients. In the SHOCK trial, among patients assigned to ERV versus IMS, 30-day mortality was 26% versus 29%, respectively, with CRH and 61% versus 81%, respectively, without CRH after commencing IABC. The corresponding 1-year mortality rates were 35% versus 52% for ERV and 69% versus 87% for IMS (interaction P ≥ .25 at both time points). After adjusting for important correlates of outcome (left ventricular ejection fraction, age, and randomization to ERV), a significant association remained between CRH and registry and trial in-hospital mortality (odds ratio 0.23, 95% CI 0.14-0.39, P < .001) and trial 1-year mortality (odds ratio .28, 95% CI 0.12-0.67, P < .001).
  
  
  CONCLUSIONS
  In CS patients, CRH after commencing IABC was independently associated with improved in-hospital, 30-day and 1-year survival regardless of early revascularization. In CS patients, CRH with IABC is an important early prognostic feature.
authors.affiliation: New York University School of Medicine, NY 10016, USA.
authors.forename: Krishnan
authors.initials: K
authors.lastname: Ramanathan
authors.forename: Michael E
authors.initials: ME
authors.lastname: Farkouh
authors.forename: John E
authors.initials: JE
authors.lastname: Cosmi
authors.forename: John K
authors.initials: JK
authors.lastname: French
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Harkness
authors.forename: Vladimír
authors.initials: V
authors.lastname: Džavík
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Sleeper
authors.forename: Judith S
authors.initials: JS
authors.lastname: Hochman
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology*; D012770:Shock, Cardiogenic / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D015996:Survival Rate / Q000639:trends; D013997:Time Factors