Author + information
- Received December 18, 2002
- Revision received April 23, 2003
- Accepted April 30, 2003
- Published online October 15, 2003.
- Timothy A. Sanborn, MD*,* (, )
- Lynn A. Sleeper, ScD†,
- John G. Webb, MD‡,
- John K. French, MBChB, PhD§,
- Geoffrey Bergman, MB, BS∥,
- Manish Parikh, MD∥,
- S.Chiu Wong, MD∥,
- Jean Boland, MD¶,
- Matthias Pfisterer, MD**,
- James N. Slater, MD††,
- Samin Sharma, MD‡‡,
- Judith S. Hochman, MD§§,
- SHOCK Investigators
- ↵*Reprint requests and correspondence:
Dr. Timothy A. Sanborn, Evanston Northwestern Healthcare, Division of Cardiology, Burch 300, 2650 Ridge Avenue, Evanston, Illinois 60201, USA.
Objectives The goal of this study was to describe the core laboratory angiographic findings of “SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK” (SHOCK) trial participants and to determine the relationship of angiographic parameters to one-year survival.
Background In the SHOCK trial, emergency revascularization improved one-year survival of patients with cardiogenic shock compared with initial medical stabilization including thrombolysis and intraaortic balloon counterpulsation.
Methods Coronary angiography was performed by protocol in 147 of 152 (97%) patients in the emergency revascularization (ERV) group and by clinical selection in 100 of 150 (67%) patients in the initial medical stabilization (IMS) group. Of the other 50 IMS patients, 45 of 50 (90%) died rapidly and did not undergo angiography.
Results Left ventricular ejection fraction was correlated with one-year survival in both treatment groups (p < 0.001). In the IMS group, the hazard ratio for death was 2.59 (95% confidence interval 1.47 to 4.58, p = 0.001) per diseased vessel (0/1 vs. 2 vs. 3). In the ERV group, the hazard ratio for death per diseased vessel was 1.11 (95% confidence interval 0.79 to 1.56, p = 0.559). Multivariate analysis of the angiography cohort (without regard for left ventriculogram measurements) identified initial Thrombolysis in Myocardial Infarction flow grade (p = 0.032), number of diseased vessels (for IMS patients only, p = 0.024), and culprit vessel (p = 0.004) as independent correlates of one-year survival, even after adjustment for key clinical factors. In the smaller cohort with left ventricular ejection fraction measured (n = 97), ejection fraction and culprit vessel remained independently correlated with survival.
Conclusions For patients in cardiogenic shock, left ventricular function and culprit vessel were independent correlates of one-year survival.
☆ Supported by grants from the National Heart, Lung, and Blood Institute (RO1-HL 50020 and RO1-HL 49970).
- Received December 18, 2002.
- Revision received April 23, 2003.
- Accepted April 30, 2003.
- American College of Cardiology Foundation