Effect of early revascularization on mortality from cardiogenic shock complicating acute myocardial infarction in california

Recent retrospective analyses of treatment of cardiogenic shock suggest that early revascularization reduces mortality. All nonfederal hospital admissions in California for 1994 with a diagnosis of acute myocardial infarction (AMI) were identified. From that cohort, patients who developed cardiogenic shock were selected to determine demographic features, procedure utilization, and outcomes of their admission compared with patients with AMI without cardiogenic shock. Multivariate logistic regression analysis was performed to assess the effect of early revascularization on survival of patients in cardiogenic shock. Cardiogenic shock was identified in 1,122 patients. Mean age was 70.4 years, 45% of patients were women, and 28% had diabetes mellitus. Shock patients were more likely to be older, diabetic, women, and having an anterior Q-wave AMI. Overall in-hospital mortality for patients with shock was 56%. Patients referred for early revascularization had more favorable risk profiles, but after multivariate analysis early revascularization remained a powerful, independent predictor of improved survival, reducing the odds of death by 80%. This population-based study suggests that early revascularization may improve in-hospital survival of patients with cardiogenic shock complicating AMI, even after adjustment for baseline differences between patients who underwent early revascularization and those who did not.