Cardiogenic shock due to acute severe mitral regurgitation complicating acute myocardial infarction: A report from the SHOCK Trial Registry

OBJECTIVES Our objective was to define the outcomes of patients with cardio genic shock (CS) due to severe mitral regurgitation (MR) complicating acute myocardial infarction (AMI). BACKGROUND Methods for early identification and optimal treatment of such p atients have not been defined. METHODS The SHOCK Trial Registry enrolled 1,190 patients with CS complicati ng AMI. We compared 1) the cohort with severe mitral regurgitation (MR, n = 98) to the cohort with predominant left ventricular failure (LVF, n = 879) , and 2) the MR patients who underwent valve surgery (n = 43) to those who did nor (n = 51). RESULTS Shock developed early after MI in both the MII. (median 12.8 h) and LVF (median 6.2 h) cohorts. The MR patients were more often female (52% vs . 37%, p = 0.004) and less likely to have ST elevation at shock diagnosis ( 41% vs. 63%, p < 0.001). The MR index MI was more frequently inferior (55% vs. 44%, p = 0.039) or posterior (32% vs. 17%, p = 0.002) than that of LVF and much less frequently anterior (34% vs. 59%, p < 0.001). Despite having higher mean LVEF (0.37 vs. 0.30, p = 0.001) the MR cohort had similar in-ho spital mortality (55% vs. 61%, p = 0.277). The majority of MR patients did not undergo mitral valve surgery. Those undergoing surgery exhibited higher mean LVEF than those not undergoing surgery; nevertheless, 39% died in hos pital. CONCLUSIONS The data highlight opportunities for early identification and i ntervention to potentially decrease the devastating mortality and morbidity of severe pose-myocardial infarction MR. (J Am Coil Cardiol 2000;36:1104-9 ) (C) 2000 by the American College of Cardiology.