Related Experiment Video
Updated: May 5, 2026
Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
One-year survival following early revascularization for cardiogenic shock
J S Hochman1, L A Sleeper, H D White
1St Luke's-Roosevelt Hospital Center, 1111 Amsterdam Ave, New York, NY 10025, USA.
Insights
Early revascularization significantly improves 1-year survival for acute myocardial infarction patients with cardiogenic shock. This intervention is particularly beneficial for those under 75 years old.
Area of Science:
- Cardiology
- Critical Care Medicine
Background:
- Cardiogenic shock (CS) is the primary cause of mortality in patients hospitalized with acute myocardial infarction (AMI).
- Effective management strategies for AMI-induced CS are crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the impact of early revascularization (ERV) on 1-year survival rates in patients experiencing AMI complicated by CS.
- To compare the efficacy of ERV versus initial medical stabilization (IMS) in this high-risk patient population.
Main Methods:
- The study involved 302 patients with AMI and CS, randomly assigned to either an ERV group or an IMS group.
- The ERV group underwent revascularization within 6 hours, while the IMS group received medical stabilization with delayed revascularization in some cases.
- Outcomes assessed included all-cause mortality and functional status at 1 year.
Main Results:
- One-year survival was significantly higher in the ERV group (46.7%) compared to the IMS group (33.6%).
- A notable treatment benefit was observed in patients younger than 75 years.
- The majority of 1-year survivors in both groups were in New York Heart Association functional class I or II.
Conclusions:
- Early revascularization improves 1-year survival for patients with AMI complicated by CS.
- Rapid transfer to centers capable of early angiography and revascularization is recommended for these patients, especially those under 75.
Context:
Cardiogenic shock (CS) is the leading cause of death for patients hospitalized with acute myocardial infarction (AMI).
Objective:
To assess the effect of early revascularization (ERV) on 1-year survival for patients with AMI complicated by CS.
Design:
The SHOCK (Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock) Trial, an unblinded, randomized controlled trial from April 1993 through November 1998.
Setting:
Thirty-six referral centers with angioplasty and cardiac surgery facilities.
Patients:
Three hundred two patients with AMI and CS due to predominant left ventricular failure who met specified clinical and hemodynamic criteria.
Interventions:
Patients were randomly assigned to an initial medical stabilization (IMS; n = 150) group, which included thrombolysis (63% of patients), intra-aortic balloon counterpulsation (86%), and subsequent revascularization (25%), or to an ERV group (n = 152), which mandated revascularization within 6 hours of randomization and included angioplasty (55%) and coronary artery bypass graft surgery (38%).
Main Outcome Measures:
All-cause mortality and functional status at 1 year, compared between the ERV and IMS groups.
Results:
One-year survival was 46.7% for patients in the ERV group compared with 33.6% in the IMS group (absolute difference in survival, 13.2%; 95% confidence interval [CI], 2.2%-24.1%; P<.03; relative risk for death, 0.72; 95% CI, 0.54-0.95). Of the 10 prespecified subgroup analyses, only age (<75 vs >/= 75 years) interacted significantly (P<.03) with treatment in that treatment benefit was apparent only for patients younger than 75 years (51.6% survival in ERV group vs 33.3% in IMS group). Eighty-three percent of 1-year survivors (85% of ERV group and 80% of IMS group) were in New York Heart Association class I or II.
Conclusions:
For patients with AMI complicated by CS, ERV resulted in improved 1-year survival. We recommend rapid transfer of patients with AMI complicated by CS, particularly those younger than 75 years, to medical centers capable of providing early angiography and revascularization procedures.
More Related Videos
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:21Cardiopulmonary Resuscitation I: Adult
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management