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 and its promoting factors is mandatory for the improvement of the survival rate of these patients. This will facilitate the providing of adequate therapeutic measures and the avoidance of others which would otherwise lead to iatrogenic shock.[1] Considering that the most common cause of cardiogenic shock is acute coronary syndrome, either with or without persistent ST-segment elevation, these patients are at higher risk and will benefit highly from these measures.[2]
Risk Factors
According to several studies, the risk factors associated with the development of cardiogenic shock include:
- Female sex, although some studies do not consider female sex as an independent predictor of poor outcome[3]
- Older age (> 65 years)[4] For every 10 years of age, the risk is 47% greater.[5]
- Prior myocardial infarction (MI)[3]
- Prior angina[3]
- Peripheral vascular disease[3]
- Left ventricular ejection fraction < 35%[4]
- Larger infarct area (estimated by serial cardiac markers)[4]
- Diabetes mellitus[4]
- Impaired fasting glucose[6]
- ST elevation[7]
- ST depression[7]
- Q waves (EKG evidence of prior myocardial infarction)[7]
- According to the analysis of PURSUIT trial database[2] 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.
- Left bundle branch block[8]
- History of hypertension[9][10]
- Heart failure on admission[9][10]
- Multivessel coronary artery disease[9][10]
- Early use of beta blockers in large infarcts[9][10]
- Systolic blood pressure < 120 mm Hg[9][10]
- Sinus tachycardia[9][10]
- Heart rate < 60 bpm[11]
- Physical findings at time of diagnosis, such as altered state of consciousness or cold and clammy skin[12]
- Oliguria[12]
- Cardiogenic shock on admission[13]
References
- ↑ Hasdai, David. (2002). Cardiogenic shock : diagnosis and treatmen. Totowa, N.J.: Humana Press. ISBN 1-58829-025-5.
- ↑ 2.0 2.1 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.
- ↑ 3.0 3.1 3.2 3.3 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.
- ↑ 4.0 4.1 4.2 4.3 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.
- ↑ Zeller M, Cottin Y, Brindisi MC, Dentan G, Laurent Y, Janin-Manificat L; et al. (2004). "Impaired fasting glucose and cardiogenic shock in patients with acute myocardial infarction". Eur Heart J. 25 (4): 308–12. doi:10.1016/j.ehj.2003.12.014. PMID 14984919.
- ↑ 7.0 7.1 7.2 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.
- ↑ 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.
- ↑ 9.0 9.1 9.2 9.3 9.4 9.5 Reynolds, H. R.; Hochman, J. S. (2008). "Cardiogenic Shock: Current Concepts and Improving Outcomes". Circulation. 117 (5): 686–697. doi:10.1161/CIRCULATIONAHA.106.613596. ISSN 0009-7322.
- ↑ 10.0 10.1 10.2 10.3 10.4 10.5 Hasdai, David; Califf, Robert M.; Thompson, Trevor D.; Hochman, Judith S.; Ohman, E.Magnus; Pfisterer, Matthias; Bates, Eric R.; Vahanian, Alec; Armstrong, Paul W.; Criger, Douglas A.; Topol, Eric J.; Holmes, David R. (2000). "Predictors of cardiogenic shock after thrombolytic therapy for acute myocardial infarction". Journal of the American College of Cardiology. 35 (1): 136–143. doi:10.1016/S0735-1097(99)00508-2. ISSN 0735-1097.
- ↑ 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) - ↑ 12.0 12.1 Hasdai D, Holmes DR, Califf RM, Thompson TD, Hochman JS, Pfisterer M; et al. (1999). "Cardiogenic shock complicating acute myocardial infarction: predictors of death. GUSTO Investigators. Global Utilization of Streptokinase and Tissue-Plasminogen Activator for Occluded Coronary Arteries". Am Heart J. 138 (1 Pt 1): 21–31. PMID 10385759.
- ↑ Jeger RV, Harkness SM, Ramanathan K, Buller CE, Pfisterer ME, Sleeper LA; et al. (2006). "Emergency revascularization in patients with cardiogenic shock on admission: a report from the SHOCK trial and registry". Eur Heart J. 27 (6): 664–70. doi:10.1093/eurheartj/ehi729. PMID 16423873.