title: [Clinical characteristics, management and prognostic evolution of patients admitted within six hours of symptom onset with st-segment elevation acute myocardial infarction complicated by cardiogenic shock : twenty year monocentric study].
abstract: BACKGROUND
  Cardiogenic shock is one of the most serious complications of the acute myocardial infarction. Advances in interventional cardiology and early reperfusion strategy improved its management.
  
  
  OBJECTIVE
  Analysis of the clinical characteristics, management and prognostic evolution of patients admitted within 6 hours onset with ST-segment elevation acute myocardial infarction complicated by cardiogenic shock.
  
  
  METHODS
  Follow-up study based on 2200 consecutive patients admitted with STEMI within 6 hours of symptom onset from 1988 to 2008. Among them 114 matched the criteria of cardiogenic shock. These were divided in two groups, according to the period: group 1 (N=57, among the first 1100 STEMI from 1988 to 1998) and group 2 (N=57, among the following 1100 STEMI from 1999 to 2008).
  
  
  RESULTS
  This trial shows a similar rate of cardiogenic shock in STEMI (5%) in both 1100 patients groups. There is no overall change in patient's clinical characteristics, but improvements in earlier management, prehospital fibrinolysis and ventricular fibrillation treatment have been detected. Primary percutaneous coronary intervention was the most common revascularisation strategy. The proportion of patients achieving acute TIMI-3 flow in the infarct related artery increased (61% vs 80%, p= 0.11) but the mortality was still high (74% vs 63%, p= 0.22).
  
  
  CONCLUSIONS
  The clinical characteristics of cardiogenic shock remain unchanged; its management is more successful with more often early reperfusion. The decline of mortality is unfortunately not significant. More aggressive treatment should probably be considered to improve outcomes.
authors.affiliation: CHU Bichat Claude Bernard, Paris, France.
authors.forename: Sami
authors.initials: S
authors.lastname: Marouene
authors.forename: Jean Michel
authors.initials: JM
authors.lastname: Juliard
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Golmard
authors.forename: Pierre
authors.initials: P
authors.lastname: Aubry
authors.forename: Gregory
authors.initials: G
authors.lastname: Ducrocq
authors.forename: Laurent
authors.initials: L
authors.lastname: Feldman
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: Alec
authors.initials: A
authors.lastname: Vahanian
mesh_terms: D000368:Aged; D015331:Cohort Studies; D004632:Emergency Medical Services; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data; D011379:Prognosis; D012770:Shock, Cardiogenic / Q000401:mortality* / Q000628:therapy*; D061665:Time-to-Treatment
chemical_list: D005343:Fibrinolytic Agents