Myocardial infarction: cardiogenic shock and arrhythmias were common in the first 30 days.

Clinical bottom line (level 4)

  1. Common complications following myocardial infarction included arrhythmias and cardiogenic shock.
  2. Half of patients who developed cardiogenic shock were dead within 30 days.
  3. Few patients developed acute mitral regurgitation or ventricular septal defect.
Holmes et al: Journal of the American College of Cardiology 1995; 26 (3): 668-674
Expires March 2003

The study

Prospective cohort study with objective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: 1081 acute hospitals in North America, Europe, Australia, New Zealand and Israel

41021 patients (aged mean 65 years, 67% male) with a first myocardial infarction
All patients received thrombolysis and heparin.

100% followed for 30 days
Outcomes studied:
  • AV block
  • asystole
  • sustained ventricular tachycardia
  • ventricular fibrillation
  • acute mitral regurgitation
  • ventricular septal defect
  • cardiogenic shock
  • death with cardiogenic shock

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)    		 NNF
    (95% CI)
    AV block 30 days 3359/41021 8.2%
    (7.9% to 8.5%)    		 12
    (12 to 13)
    asystole 30 days 2321/41021 5.7%
    (5.4% to 5.9%)    		 18
    (17 to 18)
    sustained ventricular tachycardia 30 days 2504/41021 6.1%
    (5.9% to 6.3%)    		 16
    (16 to 17)
    ventricular fibrillation 30 days 2717/41021 6.6%
    (6.4% to 6.9%)    		 15
    (15 to 16)
    acute mitral regurgitation 30 days 571/41021 1.4%
    (1.3% to 1.5%)    		 72
    (66 to 78)
    ventricular septal defect 30 days 195/41021 0.48%
    (0.41% to 0.54%)    		 210
    (190 to 250)
    cardiogenic shock 30 days 2972/41021 7.3%
    (7.0% to 7.5%)    		 14
    (13 to 14)
    death with cardiogenic shock 30 days 1647/2972 55%
    (54% to 57%)    		 2
    (2 to 2)

    Citation

    1. Holmes DR, Bates ER, Kleiman NS, et al: Contemporary reperfusion therapy for cardiogenic shock: The GUSTO-I trial experience. Journal of the American College of Cardiology 1995; 26 (3): 668-674
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    Contributor: Chris Ball and Clare Wotton, February 2000
    Reviewer:

    Clinical Question.
    Patient myocardial infarction
    Intervention or Exposure prevalence
    Outcome complications