Hochman J S, Buller C E, Sleeper L A, Boland J, Dzavik V, Sanborn T A, Godfrey E, White H D, Lim J, LeJemtel T
St. Luke's-Roosevelt Hospital Center and Columbia University, New York, New York, USA.
J Am Coll Cardiol. 2000 Sep;36(3 Suppl A):1063-70. doi: 10.1016/s0735-1097(00)00879-2.
This SHOCK Study report seeks to provide an overview of patients with cardiogenic shock (CS) complicating acute myocardial infarction (MI) and the outcome with various treatments. The outcome of patients undergoing revascularization in the SHOCK Trial Registry and SHOCK Trial are compared.
Cardiogenic shock is the leading cause of death in patients hospitalized for acute MI. The randomized SHOCK Trial reported improved six-month survival with early revascularization.
Patients with CS complicating acute MI who were not enrolled in the concurrent randomized trial were registered. Patient characteristics were recorded as were procedures and vital status at hospital discharge.
Between April 1993 and August 1997, 1,190 patients with CS were registered and 232 were randomized in the SHOCK Trial. Predominant left ventricular failure (78.5%) was most common, with isolated right ventricular shock in 2.8%, severe mitral regurgitation in 6.9%, ventricular septal rupture in 3.9% and tamponade in 1.4%. In-hospital Registry mortality was 60%, with ventricular septal rupture associated with a significantly higher mortality (87.3%) than all other categories (p < 0.01). The risk profile and mortality were lower for Registry patients who were managed with thrombolytic therapy and/or intra-aortic balloon counter-pulsation, coronary angiography, angioplasty and/or coronary artery bypass surgery. After adjusting for these differences, the extent to which survival was improved with early revascularization was similar to that observed in the randomized SHOCK Trial.
In this prospective Registry the etiology of CS was a mechanical complication in 12%. The similarity of the beneficial treatment effect in patients undergoing early revascularization in the SHOCK Trial Registry and SHOCK Trial provides strong support for the generalizability of the SHOCK Trial results.
本休克研究报告旨在概述并发急性心肌梗死（MI）的心源性休克（CS）患者以及各种治疗方法的疗效。比较休克试验注册库和休克试验中接受血运重建患者的疗效。
心源性休克是急性心肌梗死住院患者死亡的主要原因。随机进行的休克试验报告称，早期血运重建可改善6个月生存率。
登记未纳入同期随机试验的并发急性心肌梗死的心源性休克患者。记录患者特征以及出院时的治疗措施和生命状态。
1993年4月至1997年8月期间，登记了1190例心源性休克患者，其中232例在休克试验中被随机分组。主要的左心室衰竭（78.5%）最为常见，孤立性右心室休克占2.8%，严重二尖瓣反流占6.9%，室间隔破裂占3.9%，心包填塞占1.4%。登记库患者的院内死亡率为60%，室间隔破裂患者的死亡率（87.3%）显著高于所有其他类型（p<0.01）。接受溶栓治疗和/或主动脉内球囊反搏、冠状动脉造影、血管成形术和/或冠状动脉搭桥手术治疗的登记库患者的风险特征和死亡率较低。在对这些差异进行调整后，早期血运重建改善生存率的程度与随机进行的休克试验中观察到的相似。
在这个前瞻性登记库中，12%的心源性休克病因是机械性并发症。休克试验注册库和休克试验中接受早期血运重建患者的有益治疗效果相似，这为休克试验结果的可推广性提供了有力支持。
