You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.


ABOUT JAMA
Advanced Search

Welcome   | My Account | E-mail Alerts | Access Rights | Sign In


  Vol. 294 No. 4, July 27, 2005 TABLE OF CONTENTS
  JAMA
  •  Online Features
  Original Contribution
 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 (88)
 •Contact me when this article is cited
 Related Content
 •Similar articles in JAMA
 Topic Collections
 •Revascularization
 •Cardiovascular System
 •Surgery
 •Surgical Interventions
 •Cardiovascular/ Cardiothoracic Surgery
 •Prognosis/ Outcomes
 •Cardiovascular Disease/ Myocardial Infarction
 •Cardiovascular Intervention
 •Alert me on articles by topic
 Social Bookmarking
  Add to CiteULike Add to Connotea Add to Del.icio.us Add to Digg Add to Reddit Add to Technorati Add to Twitter What's this?

Trends in Management and Outcomes of Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock

Anvar Babaev, MD, PhD; Paul D. Frederick, MPH, MBA; David J. Pasta, MS; Nathan Every, MD, MPH; Tina Sichrovsky, MD; Judith S. Hochman, MD; for the NRMI Investigators

JAMA. 2005;294:448-454.

Context  Early mechanical revascularization in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock is a therapeutic strategy that reduces mortality. It has been a class I recommendation in guidelines from the American College of Cardiology and the American Heart Association since 1999 for patients younger than 75 years. However, little is known about implementation of these guidelines in practice.

Objectives  To assess trends in early revascularization and mortality for patients with cardiogenic shock complicating AMI and to determine whether the national guidelines affect revascularization rates.

Design, Setting, and Patients  Prospective, observational study of 293 633 patients with ST-elevation myocardial infarction (25 311 [8.6%] had cardiogenic shock; 7356 [29%] had cardiogenic shock at hospital presentation) enrolled in the National Registry of Myocardial Infarction (NRMI) from January 1995 to May 2004 at 775 US hospitals with revascularization capability (defined as the capability to perform cardiac catheterization, percutaneous coronary intervention [PCI], and open-heart surgery).

Main Outcome Measures  Management patterns and in-hospital mortality rates.

Results  There was an increase in primary PCI rates from 27.4% to 54.4% (P<.001) in hospitals with revascularization capability that paralleled the change in PCI for ST-elevation myocardial infarction. There was no significant change in rates of immediate coronary artery bypass graft surgery (from 2.1% to 3.2%). Propensity-adjusted multivariable analyses demonstrated that primary PCI was associated with a decreased odds of death during hospitalization (odds ratio, 0.46; 95% confidence interval, 0.40-0.53). There were no differences in the rates of change in revascularization rates based on the date when the guidelines were released regardless of patient age. Overall in-hospital cardiogenic shock mortality decreased from 60.3% in 1995 to 47.9% in 2004 (P<.001).

Conclusions  The use of PCI for patients with cardiogenic shock was associated with improved survival in a large group of hospitals with revascularization capability. The American College of Cardiology and American Heart Association guidelines had no detectable temporal impact on revascularization rates. These findings support the need for increased adherence to these guidelines.


Author Affiliations: Cardiovascular Clinical Research Center, New York University School of Medicine, New York, NY (Drs Babaev and Hochman); Ovation Research Group, Seattle, Wash (Mr Frederick); Ovation Research Group and University of California, San Francisco (Mr Pasta); Department of Cardiology, School of Medicine, University of Washington, Seattle (Dr Every); and Division of Cardiology, St Luke’s-Roosevelt Medical Center, New York, NY (Dr Sichrovsky).



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

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Percutaneous left ventricular assist devices vs. intra-aortic balloon pump counterpulsation for treatment of cardiogenic shock: a meta-analysis of controlled trials
Cheng et al.
Eur Heart J 2009;30:2102-2108.
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  

Patients with prior coronary artery bypass grafting have a poor outcome after myocardial infarction: an analysis of the VALsartan in acute myocardial iNfarcTion trial (VALIANT)
Berry et al.
Eur Heart J 2009;30:1450-1456.
ABSTRACT | FULL TEXT  

Decreasing Incidence of Critical Limb Ischemia After Intra-aortic Balloon Pump Counterpulsation
Dick et al.
ANGIOLOGY 2009;60:235-241.
ABSTRACT  

Thirty-Year Trends (1975 to 2005) in the Magnitude of, Management of, and Hospital Death Rates Associated With Cardiogenic Shock in Patients With Acute Myocardial Infarction: A Population-Based Perspective
Goldberg et al.
Circulation 2009;119:1211-1219.
ABSTRACT | FULL TEXT  

A systematic review and meta-analysis of intra-aortic balloon pump therapy in ST-elevation myocardial infarction: should we change the guidelines?
Sjauw et al.
Eur Heart J 2009;30:459-468.
ABSTRACT | FULL TEXT  

Cardiogenic shock: to pump or not to pump?
Thiele and Schuler
Eur Heart J 2009;30:389-390.
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  

Contemporary Management of Cardiogenic Shock: Age Is Opportunity
Hochman and Skolnick
J Am Coll Cardiol Intv 2009;2:153-155.
FULL TEXT  

Clinical Significance of Post-Procedural TIMI Flow in Patients With Cardiogenic Shock Undergoing Primary Percutaneous Coronary Intervention
Mehta et al.
J Am Coll Cardiol Intv 2009;2:56-64.
ABSTRACT | FULL TEXT  

A Randomized Clinical Trial to Evaluate the Safety and Efficacy of a Percutaneous Left Ventricular Assist Device Versus Intra-Aortic Balloon Pumping for Treatment of Cardiogenic Shock Caused by Myocardial Infarction
Seyfarth et al.
J Am Coll Cardiol 2008;52:1584-1588.
ABSTRACT | FULL TEXT  

Ten-Year Trends in the Incidence and Treatment of Cardiogenic Shock
Jeger et al.
ANN INTERN MED 2008;149:618-626.
ABSTRACT | FULL TEXT  

Utilization and outcome of coronary revascularization and valve procedures in acute heart failure - an evaluation based on the classification from the European Society of Cardiology
Hermansen et al.
ICVTS 2008;7:833-838.
ABSTRACT | FULL TEXT  

Protective Effects of Epidural Analgesia on Pulmonary Complications After Abdominal and Thoracic Surgery: A Meta-Analysis
Popping et al.
Arch Surg 2008;143:990-999.
ABSTRACT | FULL TEXT  

Angioplasty Strategies in ST-Segment-Elevation Myocardial Infarction: Part I: Primary Percutaneous Coronary Intervention
Stone
Circulation 2008;118:538-551.
FULL TEXT  

Angioplasty Strategies in ST-Segment-Elevation Myocardial Infarction: Part II: Intervention After Fibrinolytic Therapy, Integrated Treatment Recommendations, and Future Directions
Stone
Circulation 2008;118:552-566.
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  

Reperfusion after primary angioplasty for ST-elevation myocardial infarction: predictors of success and relationship to clinical outcomes in the APEX-AMI Angiographic Study
Brener et al.
Eur Heart J 2008;29:1127-1135.
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  

Cardiogenic Shock: Current Concepts and Improving Outcomes
Reynolds and Hochman
Circulation 2008;117:686-697.
FULL TEXT  

Lack of Benefit From Nitric Oxide Synthase Inhibition in Patients With Cardiogenic Shock: Looking for the Reasons
Ndrepepa et al.
JAMA 2007;297:1711-1713.
FULL TEXT  

Effect of Tilarginine Acetate in Patients With Acute Myocardial Infarction and Cardiogenic Shock: The TRIUMPH Randomized Controlled Trial
The TRIUMPH Investigators
JAMA 2007;297:1657-1666.
ABSTRACT | FULL TEXT  

Weekend versus Weekday Admission and Mortality from Myocardial Infarction
Kostis et al.
NEJM 2007;356:1099-1109.
ABSTRACT | FULL TEXT  

Clinical impact of direct referral to primary percutaneous coronary intervention following pre-hospital diagnosis of ST-elevation myocardial infarction
Ortolani et al.
Eur Heart J 2006;27:1550-1557.
ABSTRACT | FULL TEXT  

Pre-hospital diagnosis of myocardial infarction: an opportunity to improve outcomes?
Walsh et al.
Eur Heart J 2006;27:1515-1516.
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  

The Year in Interventional Cardiology
Dixon et al.
J Am Coll Cardiol 2006;47:1689-1706.
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  

Massive Pulmonary Embolism
Kucher et al.
Circulation 2006;113:577-582.
ABSTRACT | FULL TEXT  

Early Mechanical Revascularization Recommended for MI with Cardiogenic Shock
JWatch Emergency Med. 2005;2005:1-1.
FULL TEXT  

PCI Improves Outcome in AMI Patients with Cardiogenic Shock
Journal Watch Cardiology 2005;2005:1-1.
FULL TEXT  

What's new in the other general journals
Tonks
BMJ 2005;331:311-312.
FULL TEXT  





HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | SUBMIT | SUBSCRIBE | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 2005 American Medical Association. All Rights Reserved.