One-year survival among patients with acute myocardial infarction complicated by cardiogenic shock, and its relation to early revascularization: Results from the GUSTO-I trial

Peter B. Berger, Robert H. Tuttle, David Holmes, Eric J. Topol, Philip E. Aylward, John H. Horgan, Robert M. Califf

Research output: Contribution to journalArticle

77 Citations (Scopus)

Abstract

Background - Although 30-day survival is increased in patients with acute myocardial infarction complicated by cardiogenic shock who undergo coronary revascularization, the longer-term outcome in such patients and the duration of benefit from revascularization are unknown. Methods and Results - We analyzed 30-day survivors of acute myocardial infarction in the Global Utilization of Streptokinase and Tissue-Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I) trial and identified 36 333 who had not had cardiogenic shock (systolic blood pressure <90 mm Hg for ≥ 1 hour, group 1) and 1321 patients who had shock (group 2). Group 2 patients were older and sicker. At 1 year, 97.4% of group 1 patients were alive versus 88.0% of group 2 (P = 0.0001). Among group 2 patients, 578 (44%) had undergone revascularization within 30 days (group 2A) and 728 (56%) had not (group 2B). Revascularization was not required by protocol but was selected by the attending physicians. At 1 year, 91.7% of group 2A patients were alive versus 85.3% of group 2B (P = 0.0003). With the use of multivariable logistic regression analysis to adjust for differences in baseline characteristics of shock patients alive at 30 days, revascularization within 30 days was independently associated with reduced 1-year mortality (odds ratio 0.6, [95% confidence interval 0.4, 0.9], P = 0.007). Conclusions - Most patients (88%) with acute myocardial infarction complicated by cardiogenic shock who are alive at 30 days survived at least 1 year. Shock patients who underwent revascularization within 30 days had improved survival at 1 year compared with shock patients who did not receive revascularization, even after adjustment for differences in baseline characteristics between the 2 groups.

Original languageEnglish (US)
Pages (from-to)873-878
Number of pages6
JournalCirculation
Volume99
Issue number7
DOIs
StatePublished - Feb 23 1999

Fingerprint

Cardiogenic Shock
Myocardial Infarction
Survival
Shock
Blood Pressure
Streptokinase
Tissue Plasminogen Activator
Survivors
Coronary Vessels
Logistic Models
Odds Ratio
Regression Analysis
Confidence Intervals
Physicians

Keywords

  • Acute myocardial infarction
  • Mortality
  • Revascularization
  • Shock
  • Thrombolysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

One-year survival among patients with acute myocardial infarction complicated by cardiogenic shock, and its relation to early revascularization : Results from the GUSTO-I trial. / Berger, Peter B.; Tuttle, Robert H.; Holmes, David; Topol, Eric J.; Aylward, Philip E.; Horgan, John H.; Califf, Robert M.

In: Circulation, Vol. 99, No. 7, 23.02.1999, p. 873-878.

Research output: Contribution to journalArticle

Berger, Peter B. ; Tuttle, Robert H. ; Holmes, David ; Topol, Eric J. ; Aylward, Philip E. ; Horgan, John H. ; Califf, Robert M. / One-year survival among patients with acute myocardial infarction complicated by cardiogenic shock, and its relation to early revascularization : Results from the GUSTO-I trial. In: Circulation. 1999 ; Vol. 99, No. 7. pp. 873-878.
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abstract = "Background - Although 30-day survival is increased in patients with acute myocardial infarction complicated by cardiogenic shock who undergo coronary revascularization, the longer-term outcome in such patients and the duration of benefit from revascularization are unknown. Methods and Results - We analyzed 30-day survivors of acute myocardial infarction in the Global Utilization of Streptokinase and Tissue-Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I) trial and identified 36 333 who had not had cardiogenic shock (systolic blood pressure <90 mm Hg for ≥ 1 hour, group 1) and 1321 patients who had shock (group 2). Group 2 patients were older and sicker. At 1 year, 97.4{\%} of group 1 patients were alive versus 88.0{\%} of group 2 (P = 0.0001). Among group 2 patients, 578 (44{\%}) had undergone revascularization within 30 days (group 2A) and 728 (56{\%}) had not (group 2B). Revascularization was not required by protocol but was selected by the attending physicians. At 1 year, 91.7{\%} of group 2A patients were alive versus 85.3{\%} of group 2B (P = 0.0003). With the use of multivariable logistic regression analysis to adjust for differences in baseline characteristics of shock patients alive at 30 days, revascularization within 30 days was independently associated with reduced 1-year mortality (odds ratio 0.6, [95{\%} confidence interval 0.4, 0.9], P = 0.007). Conclusions - Most patients (88{\%}) with acute myocardial infarction complicated by cardiogenic shock who are alive at 30 days survived at least 1 year. Shock patients who underwent revascularization within 30 days had improved survival at 1 year compared with shock patients who did not receive revascularization, even after adjustment for differences in baseline characteristics between the 2 groups.",
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T1 - One-year survival among patients with acute myocardial infarction complicated by cardiogenic shock, and its relation to early revascularization

T2 - Results from the GUSTO-I trial

AU - Berger, Peter B.

AU - Tuttle, Robert H.

AU - Holmes, David

AU - Topol, Eric J.

AU - Aylward, Philip E.

AU - Horgan, John H.

AU - Califf, Robert M.

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N2 - Background - Although 30-day survival is increased in patients with acute myocardial infarction complicated by cardiogenic shock who undergo coronary revascularization, the longer-term outcome in such patients and the duration of benefit from revascularization are unknown. Methods and Results - We analyzed 30-day survivors of acute myocardial infarction in the Global Utilization of Streptokinase and Tissue-Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I) trial and identified 36 333 who had not had cardiogenic shock (systolic blood pressure <90 mm Hg for ≥ 1 hour, group 1) and 1321 patients who had shock (group 2). Group 2 patients were older and sicker. At 1 year, 97.4% of group 1 patients were alive versus 88.0% of group 2 (P = 0.0001). Among group 2 patients, 578 (44%) had undergone revascularization within 30 days (group 2A) and 728 (56%) had not (group 2B). Revascularization was not required by protocol but was selected by the attending physicians. At 1 year, 91.7% of group 2A patients were alive versus 85.3% of group 2B (P = 0.0003). With the use of multivariable logistic regression analysis to adjust for differences in baseline characteristics of shock patients alive at 30 days, revascularization within 30 days was independently associated with reduced 1-year mortality (odds ratio 0.6, [95% confidence interval 0.4, 0.9], P = 0.007). Conclusions - Most patients (88%) with acute myocardial infarction complicated by cardiogenic shock who are alive at 30 days survived at least 1 year. Shock patients who underwent revascularization within 30 days had improved survival at 1 year compared with shock patients who did not receive revascularization, even after adjustment for differences in baseline characteristics between the 2 groups.

AB - Background - Although 30-day survival is increased in patients with acute myocardial infarction complicated by cardiogenic shock who undergo coronary revascularization, the longer-term outcome in such patients and the duration of benefit from revascularization are unknown. Methods and Results - We analyzed 30-day survivors of acute myocardial infarction in the Global Utilization of Streptokinase and Tissue-Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I) trial and identified 36 333 who had not had cardiogenic shock (systolic blood pressure <90 mm Hg for ≥ 1 hour, group 1) and 1321 patients who had shock (group 2). Group 2 patients were older and sicker. At 1 year, 97.4% of group 1 patients were alive versus 88.0% of group 2 (P = 0.0001). Among group 2 patients, 578 (44%) had undergone revascularization within 30 days (group 2A) and 728 (56%) had not (group 2B). Revascularization was not required by protocol but was selected by the attending physicians. At 1 year, 91.7% of group 2A patients were alive versus 85.3% of group 2B (P = 0.0003). With the use of multivariable logistic regression analysis to adjust for differences in baseline characteristics of shock patients alive at 30 days, revascularization within 30 days was independently associated with reduced 1-year mortality (odds ratio 0.6, [95% confidence interval 0.4, 0.9], P = 0.007). Conclusions - Most patients (88%) with acute myocardial infarction complicated by cardiogenic shock who are alive at 30 days survived at least 1 year. Shock patients who underwent revascularization within 30 days had improved survival at 1 year compared with shock patients who did not receive revascularization, even after adjustment for differences in baseline characteristics between the 2 groups.

KW - Acute myocardial infarction

KW - Mortality

KW - Revascularization

KW - Shock

KW - Thrombolysis

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