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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
18:11

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis

Published on: December 28, 2012

Cardiogenic shock in patients with acute ischemic syndromes with and without ST-segment elevation

D R Holmes1, P B Berger, J S Hochman

  • 1Mayo Clinic and Foundation, Rochester, MN 55905, USA. dholmes@mayo.edu

Circulation
|November 16, 1999
PubMed

Insights

Cardiogenic shock can occur in acute ischemic syndromes, even without ST-segment elevation. While incidence and patient profiles differ, mortality remains high for both ST-elevation and non-ST-elevation myocardial infarction patients experiencing shock.

Area of Science:

  • Cardiology
  • Acute Coronary Syndromes
  • Myocardial Infarction

Background:

  • Cardiogenic shock is typically linked to ST-segment elevation myocardial infarction.
  • Limited data exist on shock incidence and outcomes in non-ST-segment elevation myocardial infarction (NSTEMI).
  • The Global Use of Strategies To Open Occluded Coronary Arteries (GUSTO)-IIb trial provides a large dataset to investigate this.

Purpose of the Study:

  • To determine the incidence and outcomes of cardiogenic shock in patients with and without ST-segment elevation.
  • To compare the characteristics, timing, clinical course, and angiographic findings of cardiogenic shock between these two groups.

Main Methods:

  • Analysis of 12,084 patients from the GUSTO-IIb trial who did not initially present with cardiogenic shock.
  • Categorization of patients based on ST-segment elevation on the enrollment electrocardiogram (ECG).
  • Comparison of shock incidence, development time, baseline characteristics, and mortality between ST-elevation and non-ST-elevation groups.

Main Results:

  • Cardiogenic shock developed in 4.2% of ST-elevation patients versus 2.5% of non-ST-elevation patients (OR 0.581, P<0.001).
  • Shock occurred later in non-ST-elevation patients, who were older, had more diabetes and 3-vessel disease, but less TIMI grade 0 flow.
  • Mortality was high in both groups: 63% for ST-elevation and 73% for non-ST-elevation patients.

Conclusions:

  • Cardiogenic shock is a significant complication of acute ischemic syndromes, irrespective of ST-segment elevation.
  • Distinct differences exist in incidence, patient profiles, timing, and angiographic findings between ST-elevation and non-ST-elevation cardiogenic shock.
  • Mortality rates for cardiogenic shock are comparably high across both ST-elevation and non-ST-elevation myocardial infarction.
Abstract

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