Cardiogenic shock in patients with acute ischemic syndromes with and without ST-segment elevation

David R. Holmes, Peter B. Berger, Judith S. Hochman, Christopher B. Granger, Trevor D. Thompson, Robert M. Califf, Alec Vahanian, Eric R. Bates, Eric J. Topol

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164 Scopus citations

Abstract

Background - Cardiogenic shock is usually considered a sequela of ST- segment elevation myocardial infarction. There are limited prospective data on the incidence and significance of shock in non-ST-segment elevation patients. This study assessed the incidence and outcomes of cardiogenic shock developing after enrollment among patients with and without ST-segment elevation in the Global Use of Strategies To Open Occluded Coronary Arteries (GUSTO)-IIb trial. Methods and Results - Among 12 084 patients in GUSTO-IIb who did not present with cardiogenic shock, 4092 (34%) had and 7991 (66%) did not have ST-segment elevation on the enrollment ECG. Cardiogenic shock developed in 4.2% of ST-segment elevation patients compared with 2.5% of patients without ST-segment elevation (odds ratio, 0.581; 95% CI, 0.472 to 0.715; P<0.001). Shock developed significantly later among patients without ST-segment elevation. There were significant differences in baseline characteristics between shock patients with and without ST-segment elevation: Patients without ST-segment elevation were older, more frequently had diabetes mellitus and 3-vessel disease, but had less TIMI grade 0 flow at angiography. Regardless of the initial ECG, mortality was high: 63% among patients with ST-segment elevation and 73% in those without ST-segment elevation. Conclusions - Cardiogenic shock occurs in the setting of acute ischemic syndromes regardless of whether ST-segment elevation is present. The incidence, patient characteristics, timing, clinical course, and angiographic findings differ between the 2 groups. Mortality from cardiogenic shock is similarly high among patients with and without ST-segment elevation.

Original languageEnglish (US)
Pages (from-to)2067-2073
Number of pages7
JournalCirculation
Volume100
Issue number20
DOIs
StatePublished - Nov 16 1999

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Keywords

  • Acute coronary syndromes
  • Mortality
  • Myocardial infarction
  • Shock
  • Unstable angina

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Holmes, D. R., Berger, P. B., Hochman, J. S., Granger, C. B., Thompson, T. D., Califf, R. M., Vahanian, A., Bates, E. R., & Topol, E. J. (1999). Cardiogenic shock in patients with acute ischemic syndromes with and without ST-segment elevation. Circulation, 100(20), 2067-2073. https://doi.org/10.1161/01.CIR.100.20.2067