Cardiovascular medicine
Management and outcome of cardiogenic shock complicating acute
myocardial infarction in hospitals with and without on-site
catheterisation facilities
I M Barbasha, S Beharb, A Battlerc, D Hasdaic, V Boykob, S Gottliebb, J Leora, for the Israeli Thrombolytic Survey
Group
a Cardiology
Department, Soroka Medical Centre, Faculty of Health Sciences,
Ben-Gurion University of the Negev, Beer-Sheva, Israel, b Neufeld Cardiac Research
Institute, Sheba Medical Centre, Tel-Hashomer, Israel, c Cardiology
Department, Rabin Medical Centre, Petah-Tikva, Israel
Correspondence to: Dr Leor leorj{at}post.tau.ac.il
Accepted 13 February
2001
OBJECTIVE
To determine whether the
availability of on-site catheterisation and revascularisation
facilities influenced hospital management and outcome of patients with
acute myocardial infarction complicated by cardiogenic shock.
METHODSPatients with acute
myocardial infarction were enrolled prospectively in four nationwide
surveys during 1992, 1994, 1996, and 1998. The characteristics,
management, and outcome of patients with cardiogenic shock were
compared between hospitals with on-site catheterisation facilities
(group 1; 18 hospitals) and without such facilities (group 2; 8 hospitals).
RESULTSOf 5351 patients with acute
myocardial infarction, 254 (4.7%) developed cardiogenic shock. Group 1 patients (n = 186 of 3854; 4.6%) were younger (mean (SD) age, 69.6 (12) v 73.7 (10) years, p = 0.006) and had a
lower proportion of women (36% v 52%,
p = 0.03) than group 2 (n = 68 of 1243; 5.2%). There was no
difference in other characteristics including the use of thrombolysis.
Group 1 patients more often underwent coronary angiography (26%
v 4%, p < 0.001), angioplasty (21%
v 4%, p = 0.002), and intra-aortic balloon
counterpulsation (28% v 4%, p < 0.001).
Seven day mortality was lower among group 1 than among group 2 patients
(61% v 77%, p = 0.02), even after age and
sex adjustment (odds ratio (OR) 0.54; 95% confidence interval (CI)
0.28 to 1.02). This outcome benefit persisted at 30 days (74%
v 88%, p = 0.01; OR 0.45, 95% CI 0.18 to
0.98), and at 6 months (80% v 90%,
p = 0.06; OR 0.57, 95% CI 0.22 to 1.33).
CONCLUSIONSThe greater use of
invasive and interventional procedures in hospitals with
catheterisation facilities is associated with improved survival of
patients with acute myocardial infarction complicated by cardiogenic
shock. Immediate availability of invasive care facilities will improve
the outcome of cardiogenic shock in the community setting.
Keywords: percutaneous transluminal coronary angioplasty; heart failure; myocardial infarction; cardiogenic shock
© 2001 by Heart
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