Frequency of inclusion of patients with cardiogenic shock in trials of thrombolytic therapy

Col, Nananda F.; Gurwitz, Jerry H.; Alpert, Joseph S.; Goldberg, Robert J.

doi:10.1016/0002-9149(94)90206-2

Cited by 36 publications

(18 citation statements)

References 98 publications

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“…Patients with cardiogenic shock may also be more likely to be excluded from clinical trials of new approaches to treating acute myocardial infarction that are ultimately found to be beneficial. 37 As evidenced by the results of this study, cardiogenic shock continues to develop at a relatively high rate after acute myocardial infarction, even though thrombolytic agents and interventional procedures are being used more. The in-hospital death rate among patients with this complication remains high.…”

Section: Discussionmentioning

confidence: 78%

Temporal Trends in Cardiogenic Shock Complicating Acute Myocardial Infarction

et al. 1999

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Section: Discussionmentioning

confidence: 78%

Temporal Trends in Cardiogenic Shock Complicating Acute Myocardial Infarction

et al. 1999

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“…3 The incidence of shock may be higher in unselected populations because patients presenting with cardiogenic shock have often been excluded from randomized trials. 13 There are very limited prospective data regarding the development of shock in patients without ST-segment elevation. This is a very diverse group of patients with variable prognoses.…”

Section: Discussionmentioning

confidence: 99%

Cardiogenic Shock in Patients With Acute Ischemic Syndromes With and Without ST-Segment Elevation

et al. 1999

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Background-Cardiogenic shock is usually considered a sequela of ST-segment elevation myocardial infarction. There are limited prospective data on the incidence and significance of shock in nonϪST-segment elevation patients. This study assessed the incidence and outcomes of cardiogenic shock developing after enrollment among patients with and without ST-segment elevation in the Global Use of Strategies To Open Occluded Coronary Arteries (GUSTO)-IIb trial. Methods and Results-Among 12 084 patients in GUSTO-IIb who did not present with cardiogenic shock, 4092 (34%) had and 7991 (66%) did not have ST-segment elevation on the enrollment ECG. Cardiogenic shock developed in 4.2% of ST-segment elevation patients compared with 2.5% of patients without ST-segment elevation (odds ratio, 0.581; 95% CI, 0.472 to 0.715; PϽ0.001). Shock developed significantly later among patients without ST-segment elevation. There were significant differences in baseline characteristics between shock patients with and without ST-segment elevation:Patients without ST-segment elevation were older, more frequently had diabetes mellitus and 3-vessel disease, but had less TIMI grade 0 flow at angiography. Regardless of the initial ECG, mortality was high: 63% among patients with ST-segment elevation and 73% in those without ST-segment elevation. Conclusions-Cardiogenic shock occurs in the setting of acute ischemic syndromes regardless of whether ST-segment elevation is present. The incidence, patient characteristics, timing, clinical course, and angiographic findings differ between the 2 groups. Mortality from cardiogenic shock is similarly high among patients with and without ST-segment elevation.

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“…155 Initial studies showed no survival benefit of streptokinase over placebo, whereas mixed results comparing streptokinase with tissue plasminogen activator have been reported in small patient cohorts. 156 Although the large GUSTO-1 trial (Global Utilization of Tissue Plasminogen Activator and Streptokinase for Occluded Coronary Arteries) showed tissue plasminogen activator to be superior to streptokinase in the overall population, no substantial mortality benefit was observed between fibrinolytic strategies among the nearly 3000 patients with CS. 157 In addition, tissue plasminogen activator-treated patients …”

Section: Fibrinolytic Therapymentioning

confidence: 99%

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Diepen¹,

Katz²,

Albert³

et al. 2017

Circulation

1,354

1,165

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Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities. Cardiogenic shock (CS) is a low-cardiac-output state resulting in life-threatening end-organ hypoperfusion and hypoxia.1,2 Acute myocardial infarction (MI) with left ventricular (LV) dysfunction remains the most frequent cause of CS. 1,3 Advances in reperfusion therapy have been associated with improvements in survival, but significant regional disparities in evidence-based care have been reported, and in-hospital mortality remains high (27%-51%).1,4-9 Management recommendations are distributed between disease-specific statements and guidelines, and a dedicated and comprehensive clinical resource in this area is lacking. Thus, consolidating the evidence to define contemporary best medical and surgical CS practices for both MI-associated CS and other types of CS may be an important step in knowledge translation to help attenuate disparities in evidence-based care.Regional systems of care coupled with treatment algorithms have improved survival in high-acuity time-sensitive conditions such as MI, out-of-hospital cardiac arrest (OHCA), and trauma.10-12 Applying a similar framework to CS management may lead to similar improvements in survival, and CS systems of care are emerging within existing regional cardiovascular emergency care networks; however, guidance from a national expert group on structure and systems of care has not been available. 13,14 Accordingly, the purposes of this American Heart Association (AHA) scientific statement on CS are to summarize our contemporary understanding of the epidemiology, pathophysiology, and in-hospital best care practices into a single clinical resource document; to suggest a stepwise management algorithm that integrates medical, surgical, and mechanical circulatory support (MCS) therapies; and to propose a Mission: Lifelinesupported pathway for the development of integrated regionalized CS systems of care. DEFINITION OF CSAcute cardiac hemodynamic instability may result from disorders that impair function of the myocardium, valves, conduction system, or pericardium, either in isolation HISTORICAL PERSPECTIVESBefore the routine use of early revascularization, MIassociated CS had an in-hospital mortality exceeding 80%. A registry trial of 250 patients with acute MI described the association between bedside physical examination (Killip classification) for the as...

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Frequency of inclusion of patients with cardiogenic shock in trials of thrombolytic therapy

Cited by 36 publications

References 98 publications

Temporal Trends in Cardiogenic Shock Complicating Acute Myocardial Infarction

Temporal Trends in Cardiogenic Shock Complicating Acute Myocardial Infarction

Cardiogenic Shock in Patients With Acute Ischemic Syndromes With and Without ST-Segment Elevation

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

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