TY - JOUR
T1 - Long-Term Outcome and its Predictors Among Patients With ST-Segment Elevation Myocardial Infarction Complicated by Shock. Insights From the GUSTO-I Trial
AU - Singh, Mandeep
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 R.
N1 - Funding Information:
The GUSTO-I study was funded by Bayer, CIBA-Corning Diagnostics, Genentech, ICI Pharmaceuticals, and Sanofi Pharmaceuticals. Dr. Topol was chairman of the study, Dr. Califf was the principal investigator, and Dr. Holmes was a regional director. Each of their institutions received funding through contractual relationships, Duke and Cleveland Clinic with the 5 sponsors and Mayo Clinic with the Cleveland Clinic, which was the Executive Center for the GUSTO-I trial. The GUSTO Steering Committee published a manuscript about patient safety and conflict of interest: J Am Coll Cardiol 1992;19:1123–8.
PY - 2007/10/30
Y1 - 2007/10/30
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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U2 - 10.1016/j.jacc.2007.04.101
DO - 10.1016/j.jacc.2007.04.101
M3 - Article
C2 - 17964038
AN - SCOPUS:35348990181
SN - 0735-1097
VL - 50
SP - 1752
EP - 1758
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 18
ER -