TY - JOUR
T1 - Predictors of cardiogenic shock after thrombolytic therapy for acute myocardial infarction
AU - Hasdai, David
AU - Califf, Robert M.
AU - Thompson, Trevor D.
AU - Hochman, Judith S.
AU - Magnus Ohman, E.
AU - Pfisterer, Matthias
AU - Bates, Eric R.
AU - Vahanian, Alec
AU - Armstrong, Paul W.
AU - Criger, Douglas A.
AU - Topol, Eric J.
AU - Holmes, David R.
N1 - Funding Information:
This study was funded by grants from Bayer (New York, New York), CIBA-Corning (Medfield, Massachusetts), Genentech (South San Francisco, California), ICI Pharmaceuticals (Wilmington, Delaware), and Sanofi Pharmaceuticals (Paris, France).
PY - 2000/1
Y1 - 2000/1
N2 - OBJECTIVES: This study characterized clinical factors predictive of cardiogenic shock developing after thrombolytic therapy for acute myocardial infarction (AMI). BACKGROUND: Cardiogenic shock remains a common and ominous complication of AMI. By identifying patients at risk of developing shock, preventive measures may be implemented to avert its development. METHODS: We analyzed baseline variables associated with the development of shock after thrombolytic therapy in the Global Utilization of Streptokinase and Tissue- Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I) trial. Using a Cox proportional hazards model, we devised a scoring system predicting the risk of shock. This model was then validated in the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO-III) cohort. RESULTS: Shock developed in 1,889 patients a median of 11.6 h after enrollment. The major factors associated with increased adjusted risk of shock were age (χ2 = 285, hazard ratio [95% confidence interval] 1.47 [1.40, 1.53]), systolic blood pressure (χ2 = 280), heart rate (χ2 = 225) and Killip class (χ2 = 161, hazard ratio 1.70 [1.52, 1.90] and 2.95 [2.39, 3.63] for Killip II versus I and Killip III versus I, respectively) upon presentation. Together, these four variables accounted for >85% of the predictive information. These findings were transformed into an algorithm with a validated concordance index of 0.758. Applied to the GUSTO-III cohort, the four variables accounted for >95% of the predictive information, and the validated concordance index was 0.796. CONCLUSIONS: A scoring system accurately predicts the risk of shock after thrombolytic therapy for AMI based primarily on the patient's age and physical examination on presentation.
AB - OBJECTIVES: This study characterized clinical factors predictive of cardiogenic shock developing after thrombolytic therapy for acute myocardial infarction (AMI). BACKGROUND: Cardiogenic shock remains a common and ominous complication of AMI. By identifying patients at risk of developing shock, preventive measures may be implemented to avert its development. METHODS: We analyzed baseline variables associated with the development of shock after thrombolytic therapy in the Global Utilization of Streptokinase and Tissue- Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I) trial. Using a Cox proportional hazards model, we devised a scoring system predicting the risk of shock. This model was then validated in the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO-III) cohort. RESULTS: Shock developed in 1,889 patients a median of 11.6 h after enrollment. The major factors associated with increased adjusted risk of shock were age (χ2 = 285, hazard ratio [95% confidence interval] 1.47 [1.40, 1.53]), systolic blood pressure (χ2 = 280), heart rate (χ2 = 225) and Killip class (χ2 = 161, hazard ratio 1.70 [1.52, 1.90] and 2.95 [2.39, 3.63] for Killip II versus I and Killip III versus I, respectively) upon presentation. Together, these four variables accounted for >85% of the predictive information. These findings were transformed into an algorithm with a validated concordance index of 0.758. Applied to the GUSTO-III cohort, the four variables accounted for >95% of the predictive information, and the validated concordance index was 0.796. CONCLUSIONS: A scoring system accurately predicts the risk of shock after thrombolytic therapy for AMI based primarily on the patient's age and physical examination on presentation.
UR - http://www.scopus.com/inward/record.url?scp=0033968483&partnerID=8YFLogxK
U2 - 10.1016/S0735-1097(99)00508-2
DO - 10.1016/S0735-1097(99)00508-2
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C2 - 10636271
AN - SCOPUS:0033968483
SN - 0735-1097
VL - 35
SP - 136
EP - 143
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 1
ER -