SHOCK
Trial question
What is the effect of emergency revascularization in patients with shock due to LV failure complicating MI?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
32.0% female
68.0% male
N = 302
302 patients (97 female, 205 male).
Inclusion criteria: patients with shock due to LV failure complicating MI.
Key exclusion criteria: severe systemic illness, mechanical or other cause of shock, severe valvular disease, dilated cardiomyopathy, and unsuitability for revascularization.
Interventions
N=152 emergency revascularization (CABG or angioplasty within 6 hours of randomization, intraaortic balloon counterpulsation recommended).
N=150 initial medical stabilization (intensive medical treatment, intraaortic balloon counterpulsation recommended).
Primary outcome
Death at 30 days
46.7%
56%
56.0 %
42.0 %
28.0 %
14.0 %
0.0 %
Emergency
revascularization
Initial medical
stabilization
No significant
difference ↔
No significant difference in death at 30 days (46.7% vs. 56%; RR 0.83, 95% CI 0.67 to 1.04).
Secondary outcomes
Significant decrease in death at 6 months (50.3% vs. 63.1%; RR 0.8, 95% CI 0.65 to 0.98).
Safety outcomes
No significant difference in adverse events.
Significant difference in acute renal failure (13% vs. 24%).
Conclusion
In patients with shock due to LV failure complicating MI, emergency revascularization was not superior to initial medical stabilization with respect to death at 30 days.
Reference
Hochman JS, Sleeper LA, Webb JG et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med. 1999 Aug 26;341(9):625-34.
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