Research article summary (published 29 Sep 2009):

Predictors of 30-day mortality in patients with refractory cardiogenic shock following acute myocardial infarction despite a patent infarct artery.

Full Abstract

BACKGROUND: Little is known about predictors of survival in patients with persistent shock following acute myocardial infarction (MI) despite a patent infarct artery. METHODS: We examined data from TRIUMPH, a multicenter randomized clinical trial of the nitric oxide synthase inhibitor, L-N(G)-monomethyl-arginine, in patients with persistent vasopressor-dependent cardiogenic shock complicating acute MI at least 1 hour after established infarct-related artery patency. Patients who died within 30 days were compared with those who survived. Continuous variables were assessed using the Wilcoxon rank sum and categorical variables using the chi(2) test. Prespecified baseline variables were included in a multivariable logistic regression model to predict mortality. A second model incorporating baseline vasopressors and dosages and a third model including change in systolic blood pressure at 2 hours were also developed. Bootstrapping was used to assess the stability of model variables. RESULTS: Of 396 patients, 180 (45.5%) died within 30 days. Systolic blood pressure (SBP), measured on vasopressor support, and creatinine clearance were significant predictors of mortality in all models. The number of vasopressors and norepinephrine dose were also predictors of mortality in the second model, but the latter was no longer significant when change in SBP at 2 hours was added as a covariate in the third model. CONCLUSIONS: The SBP, creatinine clearance, and number of vasopressors are significant predictors of mortality in patients with persistent vasopressor-dependent cardiogenic shock following acute MI despite a patent infarct artery. These prognostic variables may be useful for risk-stratification and in selecting patients for investigation of additional therapies.

Author information

Author/s: Katz, Jason N (JN); Stebbins, Amanda L (AL); Alexander, John H (JH); Reynolds, Harmony R (HR); Pieper, Karen S (KS); Ruzyllo, Witold (W); Werdan, Karl (K); Geppert, Alexander (A); Dzavik, Vladimir (V); Van de Werf, Frans (F); Hochman, Judith S (JS); TRIUMPH Investigators;

Affiliation: University of North Carolina School of Medicine, Chapel Hill, NC 27599-7875, USA. Jason_Katz(-atsign-)med.unc.edu

Journal and publication information

Publication Type: Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial

Journal: American heart journal (Am Heart J), published in United States. (Language: eng)

Reference: 2009-Oct; vol 158 (issue 4) : pp 680-7

Dates: Created 2009/09/28; Completed 2009/10/20;

PMID: 19781431, status: MEDLINE (last retrieval date: 10/20/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Aged Arginine - administration & dosage; analogs & derivatives Coronary Vessels - physiopathology Dose-Response Relationship, Drug Double-Blind Method Drug Therapy, Combination Europe - epidemiology Female Follow-Up Studies Humans Male Middle Aged

Myocardial Infarction - complications; drug therapy; physiopathology Nitric Oxide Synthase - antagonists & inhibitors Norepinephrine - administration & dosage Ontario - epidemiology Prognosis Prospective Studies Shock, Cardiogenic - etiology; mortality; prevention & control Survival Rate - trends Time Factors United States - epidemiology Vascular Patency - physiology Vasoconstrictor Agents - administration & dosage

Associated Chemicals: N(G)-monomethylarginine acetate (0) ; Vasoconstrictor Agents (0) ; Norepinephrine (51-41-2) ; Arginine (74-79-3) ; Nitric Oxide Synthase (EC 1.14.13.39)

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