Diabetes mellitus in cardiogenic shock complicating acute myocardial infarction: A report from the SHOCK Trial Registry

OBJECTIVES We sought to examine the role of diabetes mellitus in cardiogeni c shock (CS) complicating acute myocardial infarction (AMI) in the SHOCK Tr ial Registry. BACKGROUND The characteristics, outcomes and optimal treatment of diabetic patients with CS complicating AMI have not been well described. METHODS Baseline characteristics, clinical and hemodynamic measures, treatm ent variables, shock etiologies and comorbid conditions were compared for 3 79 diabetic and 784 nondiabetic patients. Logistic regression was used to e xamine the association between diabetes and in-hospital mortality, after ad justment for baseline differences. RESULTS Diabetics were less Likely than nondiabetics to undergo thrombolysi s (28% vs. 37%; p = 0.002) or attempted revascularization (40% vs. 49%; p = 0.008). The survival benefit for diabetics selected for percutaneous or su rgical revascularization (55% vs. 19% without revascularization) was simila r to that for nondiabetics (59% vs. 25%). Overall unadjusted in-hospital mo rtality was significantly higher for diabetics (67% vs. 58%; p = 0.007), bu t diabetes was only a borderline predictor of mortality after adjustment fo r baseline and treatment differences (odds ratio for death, 1.36; 95% confi dence interval, 1.00 to 1.84; p = 0.051). CONCLUSIONS Diabetics with CS complicating AMI have a higher-risk profile a t baseline, but after adjustment, diabetics have an in-hospital survival ra te that is only marginally lower than that of nondiabetics. Diabetics who u ndergo revascularization derive a survival benefit similar to that of nondi abetics. (J Am Coll Cardiol 2000;36:1097-103) (C) 2000 by the American Coll ege of Cardiology.