Management and outcome of cardiogenic shock complicating acute myocardial infarction in hospitals with and without on-site catheterisation facilities

Objective-To determine whether the availability of on-site catheterisation and revascularisation facilities influenced hospital management and outcome of patients with acute myocardial infarction complicated by cardiogenic sh ock. Methods-Patients with acute myocardial infarction were enrolled prospective ly in four nationwide surveys during 1992,1994,1996, and 1998. The characte ristics, management, and outcome of patients with cardiogenic shock were co mpared between hospitals with on-site catheterisation facilities (group 1; 18 hospitals) and without such facilities (group 2; 8 hospitals). Results-Of 5351 patients with acute myocardial infarction, 254 (4.7%) devel oped cardiogenic shock. Group 1 patients (n = 186 of 3854; 4.6%) were young er (mean (SD) age, 69.6 (12) v 73.7 (10) years, p = 0.006) and had a lower proportion of women (36% v 52%, p = 0.03) than group 2 (n = 68 of 1243; 5.2 %). There was no difference in other characteristics including the use of t hrombolysis. Group 1 patients more often underwent coronary angiography (26 % v 4%, p < 0.001), angioplasty (21% v 4%, p = 0.002), and intra-aortic bal loon counterpulsation (28% v 4%, p < 0.001). Seven day mortality was lower among group 1 than among group 2 patients (61% v 77%, p = 0.02), even after age and sex adjustment (odds ratio (OR) 0.54; 95% confidence interval (CI) 0.28 to 1.02). This outcome benefit persisted at 30 days (74% v 88%, p = 0 .01; OR 0.45,95% CI 0.18 to 0.98), and at 6 months (80% v 90%, p = 0.06; OR 0.57,95% CI 0.22 to 1.33). Conclusions-The greater use of invasive and interventional procedures in ho spitals with catheterisation facilities is associated with improved surviva l of patients with acute myocardial infarction complicated by cardiogenic s hock. Immediate availability of invasive care facilities will improve the o utcome of cardiogenic shock in the community setting.