• Giuseppe De Luca, Stefano Savonitto, Cesare Greco, Guido Parodi, Nevio C Dajelli Ermolli, Caterina Silva, Donata Lucci, Lucio Gonzini, Aldo P Maggioni, Claudio Cuccia, and BLITZ Investigators.
• Division of Cardiology, 'Maggiore della Carità' Hospital, Eastern Piedmont University 'A. Avogadro', and Centro di Biotecnologie per la Ricerca Medica Applicata (BRMA), Novara, Italy. giuseppe.deluca@med.unipmn.it
• J Cardiovasc Med (Hagerstown). 2008 Oct 1;9(10):1023-9.

IntroductionA relevant proportion of patients with ST-segment elevation myocardial infarction may develop cardiogenic shock after presentation, and the identification of these patients would be very important in order to improve their outcome. The aim of the current study was to identify, among patients in the BLITZ-1, the clinical predictors, and describe the outcome of patients who developed cardiogenic shock during hospitalization.MethodsThe study was a nationwide survey of patients admitted to a coronary care units for an acute myocardial infarction with or without ST-segment elevation myocardial infarction in October 2001. The 30-day follow-up was conducted by hospital visits and concerned major cardiac events occurred from hospital discharge.ResultsA total of 1345 patients presenting with ST-segment elevation myocardial infarction or left bundle branch block/pacemaker were included in this analysis. A total of 97 patients (7.2%) had cardiogenic shock, 26 patients at presentation, whereas 71 patients (73.2%) developed shock during hospital stay. Mortality was 71.8% among patients who developed cardiogenic shock during hospitalization as compared with 65.4% among those who were already in shock upon admission (P = 0.54). By multivariable analysis, we identified Killip class more than 1, lower systolic blood pressure at presentation, older age, unsuccessful reperfusion and diabetes as independent predictors of developing shock during hospitalization.ConclusionThe present study shows that the largest proportion of cardiogenic shock complicating ST-segment elevation myocardial infarction is observed after initial hospitalization, particularly in patients with Killip class more than 1, low systolic blood pressure at presentation and advanced age. The identification of these patients may help in preventing this complication by more aggressive pharmacological therapies, mechanical haemodynamic support, as well as coronary revascularization.

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