Original ArticlesAcute myocardial infarction complicated by systemic hypoperfusion without hypotension: report of the SHOCK trial registry☆
Section snippets
Methods
The SHOCK study was a prospective 30-site registry and randomized trial in patients with cardiogenic shock after acute myocardial infarction. Patients who did not meet the stringent enrollment criteria for the randomized trial, or who were not randomly assigned to one of the treatment groups, were enrolled in the SHOCK trial registry; they form the sample for this report. Between April 1993 and September 1997, 1,190 patients with suspected cardiogenic shock complicating myocardial infarction
Results
The characteristics of the 49 patients with nonhypotensive cardiogenic shock were generally similar to those of the patients with classic cardiogenic shock (Table 1), except that the patients with nonhypotensive cardiogenic shock were significantly more likely to have had an anterior myocardial infarction (P = 0.03). Median times from myocardial infarction to shock or nonhypotensive cardiogenic shock, and time from admission to shock or nonhypotensive cardiogenic shock, were not different. A
Discussion
Our observations suggest that patients with nonhypotensive cardiogenic shock are a unique subset of those with severe left ventricular failure. The condition occurs predominantly in patients with large anterior wall myocardial infarctions. By definition, these patients have clinical signs of peripheral hypoperfusion despite a systolic blood pressure >90 mm Hg without vasopressor support. This indicates ineffective tissue perfusion, and hence a severely depressed cardiac index, and is associated
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Supported by Public Health Service Grants HL50020 and HL49970.