Long-Term Outcome and its Predictors Among Patients With ST-Segment Elevation Myocardial Infarction Complicated by Shock. Insights From the GUSTO-I Trial

Mandeep Singh, Jennifer White, David Hasdai, Patricia K. Hodgson, Peter B. Berger, Eric J. Topol, Robert M. Califf, David Holmes

Research output: Contribution to journalArticle

81 Citations (Scopus)

Abstract

Objectives: This study sought to assess long-term outcome and determine its predictors among 30-day survivors of cardiogenic shock. Background: Patients with cardiogenic shock have high in-hospital and 30-day mortality, but there are little data about those who survive beyond 30 days. Methods: We analyzed baseline, in-hospital, and survival data from patients in the U.S. with ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock enrolled in the GUSTO (Global Utilization of Streptokinase and Tissue-Type Plasminogen Activator for Occluded Coronary Arteries)-I trial and compared them with patients in the same trial who did not have shock. Results: Of 22,883 patients enrolled in the U.S., shock occurred in 1,891 (8.3%); 953 (50.4%) survived 30 days and 527 (27.8%) survived 11 years. Of 20,992 U.S. patients without shock, 20,360 (96.9%) survived 30 days and 14,131 (67.3%) survived 11 years. After the first year, 2% to 4% of patients died each year regardless of whether they had cardiogenic shock. Using Cox proportional hazards models, we were able to predict long-term mortality in all U.S. GUSTO-I 30-day survivors from their baseline demographics and in-hospital complications. The strongest predictors were diabetes mellitus, cardiogenic shock, hypertension, previous myocardial infarction, current smoking, anterior infarct, higher Killip class, higher heart rate, and older age; patients >75 years were at highest risk. Percutaneous revascularization during the index hospitalization was associated with a reduced risk of death. Conclusions: Among patients with cardiogenic shock who survive 30 days after STEMI, annual mortality rates of 2% to 4% approximate those of patients without shock.

Original languageEnglish (US)
Pages (from-to)1752-1758
Number of pages7
JournalJournal of the American College of Cardiology
Volume50
Issue number18
DOIs
StatePublished - Oct 30 2007

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Shock
Cardiogenic Shock
Survivors
Mortality
ST Elevation Myocardial Infarction
Streptokinase
Tissue Plasminogen Activator
Proportional Hazards Models
Coronary Vessels
Diabetes Mellitus
Hospitalization
Heart Rate
Smoking
Myocardial Infarction
Demography
Hypertension
Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Long-Term Outcome and its Predictors Among Patients With ST-Segment Elevation Myocardial Infarction Complicated by Shock. Insights From the GUSTO-I Trial. / Singh, Mandeep; White, Jennifer; Hasdai, David; Hodgson, Patricia K.; Berger, Peter B.; Topol, Eric J.; Califf, Robert M.; Holmes, David.

In: Journal of the American College of Cardiology, Vol. 50, No. 18, 30.10.2007, p. 1752-1758.

Research output: Contribution to journalArticle

Singh, Mandeep ; White, Jennifer ; Hasdai, David ; Hodgson, Patricia K. ; Berger, Peter B. ; Topol, Eric J. ; Califf, Robert M. ; Holmes, David. / Long-Term Outcome and its Predictors Among Patients With ST-Segment Elevation Myocardial Infarction Complicated by Shock. Insights From the GUSTO-I Trial. In: Journal of the American College of Cardiology. 2007 ; Vol. 50, No. 18. pp. 1752-1758.
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abstract = "Objectives: This study sought to assess long-term outcome and determine its predictors among 30-day survivors of cardiogenic shock. Background: Patients with cardiogenic shock have high in-hospital and 30-day mortality, but there are little data about those who survive beyond 30 days. Methods: We analyzed baseline, in-hospital, and survival data from patients in the U.S. with ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock enrolled in the GUSTO (Global Utilization of Streptokinase and Tissue-Type Plasminogen Activator for Occluded Coronary Arteries)-I trial and compared them with patients in the same trial who did not have shock. Results: Of 22,883 patients enrolled in the U.S., shock occurred in 1,891 (8.3{\%}); 953 (50.4{\%}) survived 30 days and 527 (27.8{\%}) survived 11 years. Of 20,992 U.S. patients without shock, 20,360 (96.9{\%}) survived 30 days and 14,131 (67.3{\%}) survived 11 years. After the first year, 2{\%} to 4{\%} of patients died each year regardless of whether they had cardiogenic shock. Using Cox proportional hazards models, we were able to predict long-term mortality in all U.S. GUSTO-I 30-day survivors from their baseline demographics and in-hospital complications. The strongest predictors were diabetes mellitus, cardiogenic shock, hypertension, previous myocardial infarction, current smoking, anterior infarct, higher Killip class, higher heart rate, and older age; patients >75 years were at highest risk. Percutaneous revascularization during the index hospitalization was associated with a reduced risk of death. Conclusions: Among patients with cardiogenic shock who survive 30 days after STEMI, annual mortality rates of 2{\%} to 4{\%} approximate those of patients without shock.",
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AU - White, Jennifer

AU - Hasdai, David

AU - Hodgson, Patricia K.

AU - Berger, Peter B.

AU - Topol, Eric J.

AU - Califf, Robert M.

AU - Holmes, David

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N2 - Objectives: This study sought to assess long-term outcome and determine its predictors among 30-day survivors of cardiogenic shock. Background: Patients with cardiogenic shock have high in-hospital and 30-day mortality, but there are little data about those who survive beyond 30 days. Methods: We analyzed baseline, in-hospital, and survival data from patients in the U.S. with ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock enrolled in the GUSTO (Global Utilization of Streptokinase and Tissue-Type Plasminogen Activator for Occluded Coronary Arteries)-I trial and compared them with patients in the same trial who did not have shock. Results: Of 22,883 patients enrolled in the U.S., shock occurred in 1,891 (8.3%); 953 (50.4%) survived 30 days and 527 (27.8%) survived 11 years. Of 20,992 U.S. patients without shock, 20,360 (96.9%) survived 30 days and 14,131 (67.3%) survived 11 years. After the first year, 2% to 4% of patients died each year regardless of whether they had cardiogenic shock. Using Cox proportional hazards models, we were able to predict long-term mortality in all U.S. GUSTO-I 30-day survivors from their baseline demographics and in-hospital complications. The strongest predictors were diabetes mellitus, cardiogenic shock, hypertension, previous myocardial infarction, current smoking, anterior infarct, higher Killip class, higher heart rate, and older age; patients >75 years were at highest risk. Percutaneous revascularization during the index hospitalization was associated with a reduced risk of death. Conclusions: Among patients with cardiogenic shock who survive 30 days after STEMI, annual mortality rates of 2% to 4% approximate those of patients without shock.

AB - Objectives: This study sought to assess long-term outcome and determine its predictors among 30-day survivors of cardiogenic shock. Background: Patients with cardiogenic shock have high in-hospital and 30-day mortality, but there are little data about those who survive beyond 30 days. Methods: We analyzed baseline, in-hospital, and survival data from patients in the U.S. with ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock enrolled in the GUSTO (Global Utilization of Streptokinase and Tissue-Type Plasminogen Activator for Occluded Coronary Arteries)-I trial and compared them with patients in the same trial who did not have shock. Results: Of 22,883 patients enrolled in the U.S., shock occurred in 1,891 (8.3%); 953 (50.4%) survived 30 days and 527 (27.8%) survived 11 years. Of 20,992 U.S. patients without shock, 20,360 (96.9%) survived 30 days and 14,131 (67.3%) survived 11 years. After the first year, 2% to 4% of patients died each year regardless of whether they had cardiogenic shock. Using Cox proportional hazards models, we were able to predict long-term mortality in all U.S. GUSTO-I 30-day survivors from their baseline demographics and in-hospital complications. The strongest predictors were diabetes mellitus, cardiogenic shock, hypertension, previous myocardial infarction, current smoking, anterior infarct, higher Killip class, higher heart rate, and older age; patients >75 years were at highest risk. Percutaneous revascularization during the index hospitalization was associated with a reduced risk of death. Conclusions: Among patients with cardiogenic shock who survive 30 days after STEMI, annual mortality rates of 2% to 4% approximate those of patients without shock.

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