Cardiogenic shock risk factors
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
The identification of high-risk groups for developing cardiogenic shock, particularly in ACS patients (since this is the most common cause of this type of shock), and its promoting factors is mandatory for the improvement of the survival rate of these patients by providing adequate therapeutic measures and avoiding others which might otherwise lead to iatrogenic shock.[1]
Risk Factors
According to several studies there are risk factors which are associated with the development of cardiogenic shock. These include:
- Female sex[2]
- Older age (> 65 years)[3] For every 10 years of age, the risk is 47% greater.[4]
- Prior myocardial infarction (MI)[2]
- Prior angina[2]
- Peripheral vascular disease[2]
- Left ventricular ejection fraction < 35%[3]
- Diabetes mellitus[3]
- Larger infarct area (estimated by serial cardiac markers)[3]
- 3 vessel disease
- Early use of beta blockers in large infarcts
- Systolic blood pressure < 120 mm Hg
- Sinus tachycardia > 110 bpm
- Heart rate < 60 bpm[5]
- ST elevation[6]
- ST depression[6]
- Q waves (EKG evidence of prior myocardial infarction)[6]
- According to the analysis of PURSUIT trial database[7] in Non-ST-segment elevation myocardial infarction patients who received eptifibatide saw their 30-day mortality risk reduced by 50%. In this trial, risk factors for development of cardiogenic shock like age and presence of ST depression in the initial EKG, in patients with Non-ST-segment elevation myocardial infarction was also noted.
- Bundle branch block[8]
References
- ↑ Hasdai, David. (2002). Cardiogenic shock : diagnosis and treatmen. Totowa, N.J.: Humana Press. ISBN 1-58829-025-5.
- ↑ 2.0 2.1 2.2 2.3 Leor J, Goldbourt U, Reicher-Reiss H, Kaplinsky E, Behar S (1993). "Cardiogenic shock complicating acute myocardial infarction in patients without heart failure on admission: incidence, risk factors, and outcome. SPRINT Study Group". Am J Med. 94 (3): 265–73. PMID 8452150.
- ↑ 3.0 3.1 3.2 3.3 Hands, Mark E.; Rutherford, John D.; Muller, James E.; Davies, Glenn; Stone, Peter H.; Parker, Corette; Braunwald, Eugene (1989). "The in-hospital development of cardiogenic shock after myocardial infarction: Incidence, predictors of occurrence, outcome and prognostic factors". Journal of the American College of Cardiology. 14 (1): 40–46. doi:10.1016/0735-1097(89)90051-X. ISSN 0735-1097.
- ↑ Hasdai D, Califf RM, Thompson TD, Hochman JS, Ohman EM, Pfisterer M; et al. (2000). "Predictors of cardiogenic shock after thrombolytic therapy for acute myocardial infarction". J Am Coll Cardiol. 35 (1): 136–43. PMID 10636271.
- ↑ Antman, EM.; Hand, M.; Armstrong, PW.; Bates, ER.; Green, LA.; Halasyamani, LK.; Hochman, JS.; Krumholz, HM.; Lamas, GA. (2008). "2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. 51 (2): 210–47. doi:10.1016/j.jacc.2007.10.001. PMID 18191746. Unknown parameter
|month=ignored (help) - ↑ 6.0 6.1 6.2 Hathaway WR, Peterson ED, Wagner GS, Granger CB, Zabel KM, Pieper KS; et al. (1998). "Prognostic significance of the initial electrocardiogram in patients with acute myocardial infarction. GUSTO-I Investigators. Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries". JAMA. 279 (5): 387–91. PMID 9459474.
- ↑ Hasdai D, Harrington RA, Hochman JS, Califf RM, Battler A, Box JW; et al. (2000). "Platelet glycoprotein IIb/IIIa blockade and outcome of cardiogenic shock complicating acute coronary syndromes without persistent ST-segment elevation". J Am Coll Cardiol. 36 (3): 685–92. PMID 10987585.
- ↑ Sgarbossa EB, Pinski SL, Topol EJ, Califf RM, Barbagelata A, Goodman SG; et al. (1998). "Acute myocardial infarction and complete bundle branch block at hospital admission: clinical characteristics and outcome in the thrombolytic era. GUSTO-I Investigators. Global Utilization of Streptokinase and t-PA [tissue-type plasminogen activator] for Occluded Coronary Arteries". J Am Coll Cardiol. 31 (1): 105–10. PMID 9426026.