TY - JOUR
T1 - The in-hospital development of cardiogenic shock after myocardial infarction
T2 - Incidence, predictors of occurrence, outcome and prognostic factors
AU - Hands, Mark E.
AU - Rutherford, John D.
AU - Muller, James E.
AU - Davies, Glenn
AU - Stone, Peter H.
AU - Parker, Corette
AU - Braunwald, Eugene
PY - 1989/7
Y1 - 1989/7
N2 - The incidence, outcome and predictors of the in-hospital development of cardiogenic shock and its prognostic significance were analyzed in 845 patients presenting with acute myocardial infarction. Cardiogenic shock developed after hospitalization in 60 patients (7.1%). In half of these patients, cardiogenic shock developed at least 24 h after hospital admission. The in-hospital mortality rate was >15 times higher for patients with cardiogenic shock than for patients without shock (65.0% versus 4.3%, respectively, p < 0.001). Enzymatic evidence of infarct extension occurred in 23.3% of the patients with shock compared with 7.4% of those without shock (p < 0.0001). Multivariate analysis indicated that independent predictors for the in-hospital development of cardiogenic shock were age >65 years (p = 0.007), left ventricular ejection fraction on hospital admission <35% (p = 0.007), large infarct as estimated from serial enzyme determinations (that is, peak creatine kinase-MB isoenzyme >160 IUhiter (p = 0.008), history of diabetes mellitus (p = 0.011) and previous myocardial infarction (p = 0.012). Patients with three, four or five of these risk factors had a 17.9%, 33.7% or 54.4% probability, respectively, of developing cardiogenic shock after hospital admission. Left ventricular function, as reflected by left ventricular ejection fraction (p = 0.04) and severity of left ventricular wall motion abnormality (p = 0.04), was the most important determinant of in-hospital mortality in the patients with cardiogenic shock.
AB - The incidence, outcome and predictors of the in-hospital development of cardiogenic shock and its prognostic significance were analyzed in 845 patients presenting with acute myocardial infarction. Cardiogenic shock developed after hospitalization in 60 patients (7.1%). In half of these patients, cardiogenic shock developed at least 24 h after hospital admission. The in-hospital mortality rate was >15 times higher for patients with cardiogenic shock than for patients without shock (65.0% versus 4.3%, respectively, p < 0.001). Enzymatic evidence of infarct extension occurred in 23.3% of the patients with shock compared with 7.4% of those without shock (p < 0.0001). Multivariate analysis indicated that independent predictors for the in-hospital development of cardiogenic shock were age >65 years (p = 0.007), left ventricular ejection fraction on hospital admission <35% (p = 0.007), large infarct as estimated from serial enzyme determinations (that is, peak creatine kinase-MB isoenzyme >160 IUhiter (p = 0.008), history of diabetes mellitus (p = 0.011) and previous myocardial infarction (p = 0.012). Patients with three, four or five of these risk factors had a 17.9%, 33.7% or 54.4% probability, respectively, of developing cardiogenic shock after hospital admission. Left ventricular function, as reflected by left ventricular ejection fraction (p = 0.04) and severity of left ventricular wall motion abnormality (p = 0.04), was the most important determinant of in-hospital mortality in the patients with cardiogenic shock.
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U2 - 10.1016/0735-1097(89)90051-X
DO - 10.1016/0735-1097(89)90051-X
M3 - Article
C2 - 2738272
AN - SCOPUS:0024391360
SN - 0735-1097
VL - 14
SP - 40
EP - 46
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 1
ER -