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(Circulation. 1999;99:873-878.)
© 1999 American Heart Association, Inc.

Clinical Investigation and Reports

One-Year Survival Among Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock, and its Relation to Early Revascularization

Results From the GUSTO-I Trial

Peter B. Berger, MD; Robert H. Tuttle, MSPH; David R. Holmes, Jr, MD; Eric J. Topol, MD; Philip E. Aylward, MD; John H. Horgan, MD; Robert M. Califf, MD; for the GUSTO-I Investigators

From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn (P.B.B., D.R.H.); the Division of Cardiology, Duke University, Durham, NC (R.H.T., R.M.C.); the Department of Cardiology, Cleveland Clinic, Cleveland, Ohio (E.J.T.); The Department of Cardiovascular Medicine, Flinders Cardiovascular Center, Adelaide, Australia (P.E.A.); and the Department of Cardiology, Beaumont Hospital, Dublin, Ireland (J.H.H.).

Correspondence to Peter B. Berger, MD, Division of Cardiovascular Disease and Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail berger.peter{at}mayo.edu

Background—Although 30-day survival is increased in patients with acute myocardial infarction complicated by cardiogenic shock who undergo coronary revascularization, the longer-term outcome in such patients and the duration of benefit from revascularization are unknown.

Methods and Results—We analyzed 30-day survivors of acute myocardial infarction in the Global Utilization of Streptokinase and Tissue-Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I) trial and identified 36 333 who had not had cardiogenic shock (systolic blood pressure <90 mm Hg for 1 hour, group 1) and 1321 patients who had shock (group 2). Group 2 patients were older and sicker. At 1 year, 97.4% of group 1 patients were alive versus 88.0% of group 2 (P=0.0001). Among group 2 patients, 578 (44%) had undergone revascularization within 30 days (group 2A) and 728 (56%) had not (group 2B). Revascularization was not required by protocol but was selected by the attending physicians. At 1 year, 91.7% of group 2A patients were alive versus 85.3% of group 2B (P=0.0003). With the use of multivariable logistic regression analysis to adjust for differences in baseline characteristics of shock patients alive at 30 days, revascularization within 30 days was independently associated with reduced 1-year mortality (odds ratio 0.6, [95% confidence interval 0.4, 0.9], P=0.007).

Conclusions—Most patients (88%) with acute myocardial infarction complicated by cardiogenic shock who are alive at 30 days survived at least 1 year. Shock patients who underwent revascularization within 30 days had improved survival at 1 year compared with shock patients who did not receive revascularization, even after adjustment for differences in baseline characteristics between the 2 groups.

Key Words: revascularization • shock • acute myocardial infarction • thrombolysis • mortality

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