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. METHODS AND 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.
RCT Entities:
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. METHODS AND 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: J J Ferguson; M Cohen; R J Freedman; G W Stone; M F Miller; D L Joseph; E M Ohman Journal: J Am Coll Cardiol Date: 2001-11-01 Impact factor: 24.094
Authors: J S Hochman; C E Buller; L A Sleeper; J Boland; V Dzavik; T A Sanborn; E Godfrey; H D White; J Lim; T LeJemtel Journal: J Am Coll Cardiol Date: 2000-09 Impact factor: 24.094
Authors: R D Anderson; E M Ohman; D R Holmes; I Col; A L Stebbins; E R Bates; R J Stomel; C B Granger; E J Topol; R M Califf Journal: J Am Coll Cardiol Date: 1997-09 Impact factor: 24.094
Authors: V Menon; J S Hochman; A Stebbins; M Pfisterer; J Col; R D Anderson; D Hasdai; D R Holmes; E R Bates; E J Topol; R M Califf; E M Ohman Journal: Eur Heart J Date: 2000-12 Impact factor: 29.983
Authors: Mandeep Singh; Jennifer White; David Hasdai; Patricia K Hodgson; Peter B Berger; Eric J Topol; Robert M Califf; David R Holmes Journal: J Am Coll Cardiol Date: 2007-10-30 Impact factor: 24.094
Authors: R M Califf; H R Phillips; M C Hindman; D B Mark; K L Lee; V S Behar; R A Johnson; D B Pryor; R A Rosati; G S Wagner Journal: J Am Coll Cardiol Date: 1985-05 Impact factor: 24.094