Implications of the timing of onset of cardiogenic shock after acute myocardial infarction: A report from the SHOCK Trial Registry

OBJECTIVES We sought to examine the implications of the timing of onset of cardiogenic shock (CS) after acute myocardial infarction (MI). BACKGROUND Little information is available about the relationships between timing, clinical substrate, management and outcomes of shock. METHODS The multinational SHOCK Trial Registry enrolled MI patients with CS from 1993 to 1997. Cardiogenic shock was predominantly attributable to lef t ventricular (LV) failure in 815 Registry patients for whom temporal data were available. We examined factors related to the timing of shock onset an d the relation of temporal onset to in-hospital outcomes. RESULTS Overall, shock developed a median of 6.2 h after MI symptom onset. Shock onset varied by culprit artery: left main, median 1.7 h; right, 3.5 h ; circumflex, 3.9 h; left anterior descending (LAD), 11.0 h; saphenous vein graft, 10.9 h (p = 0.025). Early shock (<24 h) occurred in 74.1% and was a ssociated with chest pain at shock onset, ST-segment elevation in two or mo re leads, multiple infarct locations, inferior MI, left main disease and sm oking. Late shock (greater than or equal to 24 h) was associated with recur rent ischemia, Q waves in two or more leads and LAD culprit vessel. Mortali ty was higher in patients with early versus late shock (62.6% vs. 53.6%, p = 0.022). CONCLUSIONS Shock onset after acute MI occurred within 24 h in 74% of the p atients with predominant LV failure. Mortality was slightly higher in patie nts developing shock early rather than later. Many factors influence when s hock develops, which has implications for its management. (J Am Coil Cardio l 2000;36:1084-90) (C) 2000 by the American College of Cardiology.