Early Revascularization and Long-term Survival in Cardiogenic Shock Complicating Acute Myocardial Infarction

Abstract

The incidence of cardiogenic shock complicating acute myocardial infarction (MI) has remained constant over 25 years.^1-3 Although in-hospital mortality declined for the first time in the mid-1990s, the overall mortality rate is still 60%,^1,3 and cardiogenic shock remains the major cause of death for patients hospitalized with acute MI.^2-4 We previously reported the initial and 1-year results of the randomized Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial.^5,6 This trial demonstrated that a strategy of early revascularization in patients with cardiogenic shock resulted in a nonsignificant reduction in 30-day mortality from 55% to 46% when compared with a strategy of initial medical stabilization, a significant 13 absolute percentage points reduction in 1-year mortality and good functional status at 1 year for the majority of survivors.^7-9 We report here the long-term outcome of the SHOCK trial cohort.