This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (166)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Social Bookmarking   What's this?

Judith S. Hochman, MD; Lynn A. Sleeper, ScD; Harvey D. White, DSc; Vladimir Dzavik, MD; S. Chiu Wong, MD; Venu Menon, MD; John G. Webb, MD; Richard Steingart, MD; Michael H. Picard, MD; Mark A. Menegus, MD; Jean Boland, MD; Timothy Sanborn, MD; Christopher E. Buller, MD; Sharada Modur, MS; Robert Forman, MD; Patrice Desvigne-Nickens, MD; Alice K. Jacobs, MD; James N. Slater, MD; Thierry H. LeJemtel, MD; for the SHOCK Investigators

JAMA. 2001;285:190-192.

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.

Author Affiliations: A complete list of the institutional affiliations for the SHOCK investigators was published previously. N Engl J Med. 1999;341:625-634.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

January 10, 2001
JAMA. 2001;285(2):229-230.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Acute Coronary Syndromes: Diagnosis and Management, Part II
Kumar and Cannon
Mayo Clin Proc. 2009;84:1021-1036.
ABSTRACT | FULL TEXT  

Evaluating percutaneous support for cardiogenic shock: data shock and sticker shock
Desai and Bhatt
Eur Heart J 2009;30:2073-2075.
FULL TEXT  

Characteristics and Outcomes of Revascularized Patients With Hypertension: An International Verapamil SR-Trandolapril Substudy
Denardo et al.
Hypertension 2009;53:624-630.
ABSTRACT | FULL TEXT  

Survival of Elderly Patients Undergoing Percutaneous Coronary Intervention for Acute Myocardial Infarction Complicated by Cardiogenic Shock
Lim et al.
J Am Coll Cardiol Intv 2009;2:146-152.
ABSTRACT | FULL TEXT  

Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology:
Authors/Task Force Members et al.
Eur Heart J 2008;29:2909-2945.
FULL TEXT  

Percutaneous Ventricular Assist Device Support During Off-Pump Surgical Coronary Revascularization
Gregoric et al.
Ann. Thorac. Surg. 2008;86:637-639.
ABSTRACT | FULL TEXT  

Acute heart failure in patients with acute myocardial infarction treated with primary percutaneous coronary intervention
Santoro et al.
Eur J Heart Fail 2008;10:780-785.
ABSTRACT | FULL TEXT  

Outcome After Surgery and Percutaneous Intervention for Cardiogenic Shock and Left Main Disease
Lee et al.
Ann. Thorac. Surg. 2008;86:29-34.
ABSTRACT | FULL TEXT  

Percutaneous coronary intervention for acute MI does not prevent in-hospital development of cardiogenic shock compared to fibrinolysis
Lindholm et al.
Eur J Heart Fail 2008;10:668-674.
ABSTRACT | FULL TEXT  

Cardiac resynchronisation as a rescue therapy in patients with catecholamine-dependent overt heart failure: Results from a short and mid-term study
Milliez et al.
Eur J Heart Fail 2008;10:291-297.
ABSTRACT | FULL TEXT  

Clinical Characteristics and In-Hospital Outcomes of Patients With Cardiogenic Shock Undergoing Coronary Artery Bypass Surgery: Insights From the Society of Thoracic Surgeons National Cardiac Database
Mehta et al.
Circulation 2008;117:876-885.
ABSTRACT | FULL TEXT  

2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention
American College of Cardiology/American Heart Asso et al.
J Am Coll Cardiol 2008;51:172-209.
FULL TEXT  

2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: 2007 Writing Group to Review New Evidence and Update the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention, Writing on Behalf of the 2005 Writing Committee
King et al.
Circulation 2008;117:261-295.
FULL TEXT  

Myocardial Revascularization after Acute Myocardial Infarction
George and Oz
Card Surg Adult 2008;3:669-696.
FULL TEXT  

Hemodynamic Parameters Are Prognostically Important in Cardiogenic Shock But Similar Following Early Revascularization or Initial Medical Stabilization: A Report From the SHOCK Trial
Jeger et al.
Chest 2007;132:1794-1803.
ABSTRACT | FULL TEXT  

Metabolic Profiling of Arginine and Nitric Oxide Pathways Predicts Hemodynamic Abnormalities and Mortality in Patients With Cardiogenic Shock After Acute Myocardial Infarction
Nicholls et al.
Circulation 2007;116:2315-2324.
ABSTRACT | FULL TEXT  

The Calm After the Storm: Long-Term Survival After Cardiogenic Shock
Hochman and Apolito
J Am Coll Cardiol 2007;50:1759-1760.
FULL TEXT  

Long-Term Outcome and its Predictors Among Patients With ST-Segment Elevation Myocardial Infarction Complicated by Shock: Insights From the GUSTO-I Trial
Singh et al.
J Am Coll Cardiol 2007;50:1752-1758.
ABSTRACT | FULL TEXT  

Effect of nitric oxide synthase inhibition on haemodynamics and outcome of patients with persistent cardiogenic shock complicating acute myocardial infarction: a phase II dose-ranging study
Dzavik et al.
Eur Heart J 2007;28:1109-1116.
ABSTRACT | FULL TEXT  

Clinical profile, contemporary management and one-year mortality in patients with severe acute heart failure syndromes: The EFICA study
Zannad et al.
Eur J Heart Fail 2006;8:697-705.
ABSTRACT | FULL TEXT  

Blood cardioplegia
Martin and Benk
MMCTS 2006;2006:745.
ABSTRACT | FULL TEXT  

Early revascularization and long-term survival in cardiogenic shock complicating acute myocardial infarction.
Hochman et al.
JAMA 2006;295:2511-2515.
ABSTRACT | FULL TEXT  

Emergency revascularization in patients with cardiogenic shock on admission: a report from the SHOCK trial and registry
Jeger et al.
Eur Heart J 2006;27:664-670.
ABSTRACT | FULL TEXT  

ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention)
Smith et al.
J Am Coll Cardiol 2006;47:216-235.
FULL TEXT  

ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention)
Smith et al.
Circulation 2006;113:156-175.
FULL TEXT  

Part 8: Stabilization of the Patient With Acute Coronary Syndromes
Circulation 2005;112:IV-89-IV-110.
FULL TEXT  

Immediate angioplasty after thrombolysis: a systematic review
Cantor et al.
CMAJ 2005;173:1473-1481.
ABSTRACT | FULL TEXT  

Part 5: Acute Coronary Syndromes
Circulation 2005;112:III-55-III-72.
FULL TEXT  

Comparison of Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting After Acute Myocardial Infarction Complicated by Cardiogenic Shock: Results From the Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) Trial
White et al.
Circulation 2005;112:1992-2001.
ABSTRACT | FULL TEXT  

Left ventricular assist device implantation after acute anterior wall myocardial infarction and cardiogenic shock: A two-center study
Dang et al.
J. Thorac. Cardiovasc. Surg. 2005;130:693-698.
ABSTRACT | FULL TEXT  

Diabetes mellitus and cardiogenic shock in acute myocardial infarction
Lindholm et al.
Eur J Heart Fail 2005;7:834-839.
ABSTRACT | FULL TEXT  

Trends in Management and Outcomes of Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock
Babaev et al.
JAMA 2005;294:448-454.
ABSTRACT | FULL TEXT  

Systemic Inflammatory Response Syndrome After Acute Myocardial Infarction Complicated by Cardiogenic Shock
Kohsaka et al.
Arch Intern Med 2005;165:1643-1650.
ABSTRACT | FULL TEXT  

Improving Quality of Life After Cardiogenic Shock: Do More Revascularization!
Ohman and Chang
J Am Coll Cardiol 2005;46:274-276.
FULL TEXT  

Functional Status and Quality of Life After Emergency Revascularization for Cardiogenic Shock Complicating Acute Myocardial Infarction
Sleeper et al.
J Am Coll Cardiol 2005;46:266-273.
ABSTRACT | FULL TEXT  

Management of Cardiogenic Shock Attributable to Acute Myocardial Infarction in the Reperfusion Era
Duvernoy and Bates
J Intensive Care Med 2005;20:188-198.
ABSTRACT  

Predictors of outcome after percutaneous treatment for cardiogenic shock
Sutton et al.
Heart 2005;91:339-344.
ABSTRACT | FULL TEXT  

Clinical implications of ST-segment non-resolution after thrombolysis for myocardial infarction
Bhatia et al.
JRSM 2004;97:566-570.
ABSTRACT | FULL TEXT  

Severity of heart failure, treatments, and outcomes after fibrinolysis in patients with ST-elevation myocardial infarction
Kashani et al.
Eur Heart J 2004;25:1702-1710.
ABSTRACT | FULL TEXT  

ACC/AHA guidelines for the management of patients with ST-Elevation myocardial infarction--executive summary: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (writing committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction)
Writing Committee Members et al.
J Am Coll Cardiol 2004;44:671-719.
FULL TEXT  

ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction)
Antman et al.
Circulation 2004;110:588-636.
FULL TEXT  

Recommendations on percutaneous coronary intervention for the reperfusion of acute ST elevation myocardial infarction
Montalescot et al.
Heart 2004;90:e37-e37.
ABSTRACT | FULL TEXT  

Impaired Myocardial Perfusion Is a Major Explanation of the Poor Outcome Observed in Patients Undergoing Primary Angioplasty for ST-Segment-Elevation Myocardial Infarction and Signs of Heart Failure
De Luca et al.
Circulation 2004;109:958-961.
ABSTRACT | FULL TEXT  

Primary Coronary Intervention for Acute Myocardial Infarction
Keeley and Grines
JAMA 2004;291:736-739.
FULL TEXT  

Determinants and Prognostic Impact of Heart Failure Complicating Acute Coronary Syndromes: Observations From the Global Registry of Acute Coronary Events (GRACE)
Steg et al.
Circulation 2004;109:494-499.
ABSTRACT | FULL TEXT  

Correlates of one-year survival inpatients with cardiogenic shock complicating acute myocardial infarction: Angiographic findings from the SHOCK trial
Sanborn et al.
J Am Coll Cardiol 2003;42:1373-1379.
ABSTRACT | FULL TEXT  

Percutaneous coronary intervention for cardiogenic shock in the SHOCK trial
Webb et al.
J Am Coll Cardiol 2003;42:1380-1386.
ABSTRACT | FULL TEXT  

Relation Between Hospital Intra-Aortic Balloon Counterpulsation Volume and Mortality in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Chen et al.
Circulation 2003;108:951-957.
ABSTRACT | FULL TEXT  

Cardiogenic shock: have we really found the magic potion?
Menon
Eur Heart J 2003;24:1279-1281.
FULL TEXT  

Cardiogenic Shock Complicating Acute Myocardial Infarction: Expanding the Paradigm
Hochman
Circulation 2003;107:2998-3002.
FULL TEXT  

Contemporary utilization and outcomes of intra-aortic balloon counterpulsation in acute myocardial infarction: The benchmark registry
Stone et al.
J Am Coll Cardiol 2003;41:1940-1945.
ABSTRACT | FULL TEXT  

Cardiogenic shock caused by right ventricular infarction: A report from the SHOCK registry
Jacobs et al.
J Am Coll Cardiol 2003;41:1273-1279.
ABSTRACT | FULL TEXT  

Outcome of Elderly Patients With Chronic Symptomatic Coronary Artery Disease With an Invasive vs Optimized Medical Treatment Strategy: One-Year Results of the Randomized TIME Trial
Pfisterer et al.
JAMA 2003;289:1117-1123.
ABSTRACT | FULL TEXT  

Cardiogenic Shock Complicating an Acute Myocardial Infarction: Conservative Treatment Versus Revascularization
Graaf et al.
SEMIN CARDIOTHORAC VASC ANESTH 2003;7:99-103.
 

The final common pathway
Holmes
Eur Heart J 2003;24:214-216.
FULL TEXT  

Cardiogenic shock complicating acute myocardial infarction: Prognostic impact of early and late shock development
Lindholm et al.
Eur Heart J 2003;24:258-265.
ABSTRACT | FULL TEXT  

Echocardiographic Predictors of Survival and Response to Early Revascularization in Cardiogenic Shock
Picard et al.
Circulation 2003;107:279-284.
ABSTRACT | FULL TEXT  

Management of acute myocardial infarction in patients presenting with ST-segment elevation
The Task Force on the Management of Acute Myocardi et al.
Eur Heart J 2003;24:28-66.
FULL TEXT  

Appropriate timing of surgical intervention after transmural acute myocardial infarction
Lee et al.
J. Thorac. Cardiovasc. Surg. 2003;125:115-120.
ABSTRACT | FULL TEXT  

Myocardial Revascularization after Acute Myocardial Infarction
Lee et al.
Card Surg Adult 2003;2:639-658.
FULL TEXT  

MANAGEMENT OF CARDIOGENIC SHOCK COMPLICATING ACUTE MYOCARDIAL INFARCTION
Menon and Hochman
Heart 2002;88:531-537.
FULL TEXT  

Revascularization during acute myocardial infarction: risks and benefits revisited
Albes et al.
Ann. Thorac. Surg. 2002;74:102-108.
ABSTRACT | FULL TEXT  

Reperfusion for ST-Segment Elevation Myocardial Infarction: An Overview of Current Treatment Options
Van de Werf and Baim
Circulation 2002;105:2813-2816.
FULL TEXT  

New advances in the management of acute coronary syndromes: 3. The role of catheter-based procedures
Buller and Carere
CMAJ 2002;166:51-61.
FULL TEXT  

ADDITIONAL ARTICLES ABSTRACTED IN ACP JOURNAL CLUB
Evid. Based Med. 2001;6:132-132.
FULL TEXT  

Early Revascularization Better for Cardiogenic Shock
JWatch Emergency Med. 2001;2001:1-1.
FULL TEXT  

Early Revascularization Beneficial for Cardiogenic Shock Before Age 75
Journal Watch Cardiology 2001;2001:3-3.
FULL TEXT