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

Background-Although 30-day survival is increased in patients with acute myo cardial infarction complicated by cardiogenic shock who undergo coronary re vascularization, 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 infarc tion in the Global Utilization of Streptokinase and Tissue-Plasminogen Acti vator for Occluded Coronary Arteries (GUSTO-I) trial and identified 36 333 who had not had cardiogenic shock (systolic blood pressure <90 mm Hg for gr eater than or equal to 1 hour, group 1) and 1321 patients who had shock (gr oup 2). Group 2 patients were older and sicker. At I year, 97.4% of group 1 patients were alive versus 88.0% of group 2 (P=0.0001). Among group 2 pati ents, 578 (44%) had undergone revascularization within 30 days (group 2A) a nd 728 (56%) had not (group 2B). Revascularization was not required by prot ocol but was selected by the attending physicians. At 1 year, 91.7% of grou p 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, revascularizat ion within 30 days was independently associated with reduced I-year mortali ty (odds ratio 0.6, [95% confidence interval 0.4, 0.9], P=0.007). Conclusions-Most patients (88%) with acute myocardial infarction complicate d by cardiogenic shock who are alive at 30 days survived at least I year. S hock patients who underwent revascularization within 30 days had improved s urvival at 1 year compared with shock patients who did not receive revascul arization, even after adjustment for differences in baseline characteristic s between the 2 groups.