Myocardial infarction: cardiogenic shock increased the risk of in-hospital mortality.

Clinical bottom line (level 2b)

  1. A fifth of patients who had a myocardial infarction died in-hospital.
  2. Patients who had a myocardial infarction were at an increased risk of in-hospital mortality if they had cardiogenic shock (NNF = 1 for weeks) .
Goldberg et al: New England Journal of Medicine 1991; 325 (16): 1117-1122
Expires March 2003

The study

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

Setting: 16 teaching and community hospitals, USA

4762 patients (aged mean 69 years, 57% male) hospitalised with a primary or secondary discharge diagnosis of acute myocardial infarction during 1975, 1978, 1981, 1986 and 1988.

Factors studied:
  • other factors not given
  • cardiogenic shock




    • Logistic regression was used to adjust for confounding factors.

    Over 14 years, ?100% followed for duration of hospitalisation
    Outcomes studied:
  • total in-hospital mortality
  • cardiogenic shock

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    total in-hospital mortality duration of hospitalisation 873/4762 18.3%
    (17.2% to 19.4%)
    cardiogenic shock duration of hospitalisation 358/4762 7.52%
    (6.77% to 8.27%)

    prognostic factor for
    total in-hospital mortality     		time to outcome adjusted RR
    (95% CI)    		 NNF+
    (95% CI)
    cardiogenic shock duration of hospitalisation 11.3
    (8.22 to 15.5)     		1
    (1 to 1)

    • 44% of patients developed cardiogenic shock on the first day of admission, 12% on day 2, 10% on day 3 and the remainder thereafter.

    Citation

    1. Goldberg RJ, Gore JM, Alpert JS, et al: Cardiogenic shock after acute myocardial infarction: incidence and mortality from a community-wide perspective, 1975 to 1988. New England Journal of Medicine 1991; 325 (16): 1117-1122
    Contributor: Clare Wotton and Chris Ball, February 2000
    Reviewer:

    Clinical Question.
    Patient myocardial infarction
    Intervention or Exposure incidence and mortality
    Outcome cardiogenic shock