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

Recent retrospective analyses of treatment of cardiogenic shock suggest tha t early revascularization reduces mortality. All nonfederal hospital admiss ions in California for 1994 with a diagnosis of acute myocardial infarction (AMI) were identified. From that cohort, patients who developed cardiogeni c shock were selected to determine demographic features, procedure utilizat ion, and outcomes of their admission compared with patients with AMI withou t cardiogenic shock. Multivariate logistic regression analysis was performe d to assess the effect of early revascularization on survival of patients i n cardiogenic shock. Cardiogenic shock was identified in 1,122 patients, Me an age was 70.4 years, 45% of patients were women, and 28% had diabetes mel litus, Shock patients were more likely to be older, diabetic, women, and ha ving an anterior Q-wave AMI, Overall in-hospital mortality for patients wit h shock was 56%, Patients referred for early revascularization had more fav orable risk profiles, but after multivariate analysis early revascularizati on remained a powerful, independent predictor of improved survival, reducin g the odds of death by 80%, This population-based study suggests that early revascularization may improve in-hospital survival of patients with cardio genic shock complicating AMI, even after adjustment for baseline difference s between patients who underwent early revascularization and those who did not, (C) 2000 by Excerpta Medica, Inc.