Clinical InvestigationAcute Ischemic Heart DiseaseInterhospital transfer for early revascularization in patients with ST-elevation myocardial infarction complicated by cardiogenic shock—a report from the SHould we revascularize Occluded Coronaries for cardiogenic shocK? (SHOCK) trial and registry
Section snippets
Study design
This subgroup analysis of the SHOCK Trial and Registry was prespecified in the study protocol. Details about the study design have been published previously.12 In brief, patients developing CS within 36 hours of onset of STEMI were randomized within 12 hours after CS onset to ERV or initial medical stabilization. Patients in the ERV group received PCI or coronary artery bypass graft surgery as soon as possible and within 6 hours of randomization. In the initial medical stabilization group,
Baseline characteristics
Transfer patients were younger and less often had prior hypertension, myocardial infarction, and congestive heart failure than direct-admit patients (Table I). Transfer patients more often had electrocardiographic ST-segment elevation and higher creatine phosphokinase release. Hemodynamic profiles from the time of CS onset were similar in transfer and direct-admit patients except for a faster heart rate in transfer patients. Coronary angiography was performed in 69% of the cohort. In this
Discussion
Our study shows that patients with STEMI and CS in hospitals without revascularization capability transferred to hospitals with revascularization capability represent a selected population13 with more favorable outcomes than patients directly admitted to hospitals with revascularization capability. However, adjusted mortality rates in both transfer and direct-admit patients were similar. Importantly, despite delayed time to treatment in the transfer patients, ERV resulted in a reduction of
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