This study sought to assess long-term outcome and determine its predictors among 30-day
survivors of cardiogenic shock.
Patients with cardiogenic shock have high in-hospital and 30-day mortality, but there
are little data about those who survive beyond 30 days.
We analyzed baseline, in-hospital, and survival data from patients in the U.S. with
ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock enrolled
in the GUSTO (Global Utilization of Streptokinase and Tissue-Type Plasminogen Activator
for Occluded Coronary Arteries)-I trial and compared them with patients in the same
trial who did not have shock.
Of 22,883 patients enrolled in the U.S., shock occurred in 1,891 (8.3%); 953 (50.4%)
survived 30 days and 527 (27.8%) survived 11 years. Of 20,992 U.S. patients without
shock, 20,360 (96.9%) survived 30 days and 14,131 (67.3%) survived 11 years. After
the first year, 2% to 4% of patients died each year regardless of whether they had
cardiogenic shock. Using Cox proportional hazards models, we were able to predict
long-term mortality in all U.S. GUSTO-I 30-day survivors from their baseline demographics
and in-hospital complications. The strongest predictors were diabetes mellitus, cardiogenic
shock, hypertension, previous myocardial infarction, current smoking, anterior infarct,
higher Killip class, higher heart rate, and older age; patients >75 years were at
highest risk. Percutaneous revascularization during the index hospitalization was
associated with a reduced risk of death.
Among patients with cardiogenic shock who survive 30 days after STEMI, annual mortality
rates of 2% to 4% approximate those of patients without shock.