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Cardiogenic Shock in Patients With Acute Ischemic Syndromes With and Without ST-Segment Elevation
Abstract
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 non−ST-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; P <0.001). 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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Cited by
Roffi, M., Patrono, C., Collet, J.-P., Mueller, C., Valgimigli, M., Andreotti, F., Bax, J. J., Borger, M. A., Brotons, C., Chew, D. P., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehv320 · Cited by 8,261
2023 ESC Guidelines for the management of acute coronary syndromes
Byrne, R. A., Rossello, X., Coughlan, J. J., Barbato, E., Berry, C., Chieffo, A., Claeys, M. J., Dan, G.-A., Dweck, M. R., Galbraith, M., et al. (2023) · European Heart Journal · doi:10.1093/eurheartj/ehad191 · Cited by 5,333
Collet, J.-P., Thiele, H., Barbato, E., Barthélémy, O., Bauersachs, J., Bhatt, D. L., Dendale, P., Dorobantu, M., Edvardsen, T., Folliguet, T., et al. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehaa575 · Cited by 5,037
2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes
Amsterdam, E. A., Wenger, N. K., Brindis, R. G., Casey, D. E., Ganiats, T. G., Holmes, D. R., Jaffe, A. S., Jneid, H., Kelly, R. F., Kontos, M. C., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.09.017 · Cited by 3,595
Self-citationAmsterdam, E. A., Wenger, N. K., Brindis, R. G., Casey, D. E., Ganiats, T. G., Holmes, D. R., Jaffe, A. S., Jneid, H., Kelly, R. F., Kontos, M. C., et al. (2014) · Circulation · doi:10.1161/cir.0000000000000134 · Cited by 1,059
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Metadata
- Authors
- Holmes, D. R., Berger, P. B., Hochman, J. S., Granger, C. B., Thompson, T. D., Califf, R. M., Vahanian, A., Bates, E. R., & Topol, E. J.
- Venue
- Circulation
- Published
- 1999-11-16
- Volume
- 100
- Issue
- 20
- Pages
- 2067-2073
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2157534007
- Cited by
- 248
- References
- 0
- FWCI
- 6.56
- Type
- journal article
- Language
- en
- Open access
- closed
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- Holmes, D. R., Berger, P. B., Hochman, J. S., Granger, C. B., Thompson, T. D., Califf, R. M., Vahanian, A., Bates, E. R., & Topol, E. J. (1999). Cardiogenic Shock in Patients With Acute Ischemic Syndromes With and Without ST-Segment Elevation. Circulation. https://doi.org/10.1161/01.cir.100.20.2067
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