Myocardial infarction: old age, poor left ventricular function and diabetes increased the risk of cardiogenic shock.

Clinical bottom line (level 1b)

  1. One in fourteen patients with an acute myocardial infarction developed cardiogenic shock.
  2. The risk of developing cardiogenic shock was increased with
    • age > 65
    • reduced ejection fraction
    • large elevation in CK-MB
    • diabetes mellitus
    • previous myocardial infarction
Hands et al: Journal of the American College of Cardiology 1989; 14 (1): 40-46
Expires March 2003

The study

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

Setting: acute hospitals, USA

845 patients (aged mean ~ 57, 73% male) with an acute myocardial infarction (diagnosed on typical ECG and enzyme changes)

Excluded if
  • cardiogenic shock on admission




    • A stepwise logistic regression analysis was used to adjust for confounding factors.

    ?100% followed for length of hospital stay
    Outcomes studied:
  • cardiogenic shock systolic blood pressure < 90 mmHg in the absence of hypovolaemia; a cardiac index < 2.0 l /min/m 2 with an elevated wedge pressure; and vasopressors required to maintain cardiac function

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)    		 NNF
    (95% CI)
    cardiogenic shock length of hospital stay 60/845 7.1%
    (5.4% to 8.8%)    		 14
    (11 to 19)

    • An increased risk of developing cardiogenic shock was associated with
      • age > 65
      • left ventricular ejection fraction < 35%
      • CK-MB > 160 IU
      • diabetes mellitus
      • previous myocardial infarction

    Comments

    1. Patients were enrolled in a randomised controlled study comparing the effect of propranolol or hyaluronidase on infarct size.
    2. 65% of patients with cardiogenic shock died in hospital (95% CI: 53% to 77%).
    3. No odds ratios or relative risks were reported.

    Citation

    1. Hands ME, Rutherford JD, Muller JE, et al: The in-hospital development of cardiogenic shock after myocardial infarction: incidence, predictors of occurrence, outcome and prognostic factors. Journal of the American College of Cardiology 1989; 14 (1): 40-46
    Search Terms: reference from review article
    Contributor: Chris Ball and Clare Wotton, February 2000
    Reviewer:

    Clinical Question.
    Patient myocardial infarction
    Intervention or Exposure prevalence
    Outcome cardiogenic shock