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Invasive management benefited patients with cardiogenic shock, acute MI
Patients with cardiogenic shock complicating acute MI had better outcomes after receiving invasive management compared with conservative management.
The SHOCK trial, published in 1999, demonstrated that an invasive strategy of early revascularization was associated with a mortality benefit at 6 months in patients with cardiogenic shock complicating acute MI vs. initial stabilization, according to the study background. For the new study, Sripal Bangalore, MD, MHA, and colleagues evaluated the data on real-world practice and outcomes of invasive vs. conservative management in that patient population.
Sripal Bangalore
Bangalore and colleagues analyzed data from the Nationwide Inpatient Sample 2002-2011 on patients with a primary discharge diagnosis of acute MI and a secondary diagnosis of cardiogenic shock. They identified 60,833 patients, and matched 20,644 of them based on propensity scores: 10,322 were managed conservatively and 10,322 were managed invasively. Invasive management was defined as use of cardiac catheterization, PCI or CABG. The primary outcome was in-hospital mortality.
Compared with conservative management, invasive management was associated with significantly lower odds of in-hospital mortality (37.7% vs. 59.7%; OR=0.41; 95% CI, 0.39-0.43), according to the results.
“Our results emphasize the need for aggressive management in this high-risk subgroup,” Bangalore, associate professor of medicine, director of research at the Cardiac Catheterization Laboratory and director of the Cardiovascular Outcomes Group at the Cardiovascular Clinical Research Center at New York University School of Medicine, and colleagues wrote.
The lower mortality rates for patients who received invasive management were consistent across all prespecified subgroups, even in patients aged 75 years and older, for whom invasive management was not associated with better outcomes in the SHOCK trial, according to the researchers.
Lower mortality rates for those who received invasive management were observed in those aged 75 years and older (44% vs. 63.6%; OR=0.45; 95% CI, 0.42-0.49) and in those younger than 75 years (30.6% vs. 55.1%; OR=0.36; 95% CI, 0.33-0.39), although the magnitude of risk reduction was greater in younger patients (P for interaction<.0001), the researchers wrote.
In the SHOCK trial, the discrepancy in results by age could be attributed to differences in baseline characteristics and/or small sample size, Bangalore and colleagues wrote, noting that the present findings are similar to those of the SHOCK registry.
“Our findings lend support to the recent guidelines that do not make the distinction of age in advocating for an invasive strategy,” they wrote.
Disclosure: The researchers report no relevant financial disclosures.