Cardiogenic shock occurs in approx 7% of patients in the acute infarct setting and is associated with a mortality rate >70% (29,30). Retrospective analyses of thrombolytic trials do not show a significant mortality reduction in patients presenting with cardio-genic shock (11,31,32). In an overview of 386 patients who were treated with coronary angioplasty for cardiogenic shock, Bates and Topol (31) reported an overall reperfusion rate of 73% and inhospital mortality rate of 44%. Emergency coronary bypass grafting in this setting has an associated mortality rate of approx 40% (31). The approximate 60% survival rate after coronary revascularization is better than the expected 70% mortality rate. The SHOCK trial (33) randomized 302 patients with cardiogenic shock <36 h post-MI to conventional medical therapy with thrombolysis or to acute coronary revascularization; 64% of patients received percutaneous coronary intervention (PCI) and 36% received coronary artery bypass graft (CABG). At 6 mo, mortality was significantly lower among patients receiving earlier revascularization compared to conventional therapy (50.3 vs 63.1%) (p < 0.05). Mortality was not significantly different at 30 d. Thus, an early revascularization strategy for patients with cardiogenic shock is associated with improved 6-mo survival rates.
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