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] Syed Musadiq Ali M.B.B.S.[3]
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. 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.
Risk Factors
Common Risk Factors
According to several studies and considering that left ventricular dysfunction is the most common cause of developing cardiogenic shock following myocardial infarction, the most common risk factors for this condition include:
- Older age (> 65 years)[1] For every 10 years of age, the risk is 47% greater.[2]
- Female sex, although some studies do not consider female sex as an independent predictor of poor outcome[3]
- Prior myocardial infarction (MI)[3]
- Prior angina[3]
- Peripheral vascular disease[3]
- Left ventricular ejection fraction < 35%[1]
- Moderate to severe mitral regurgitation[4]
- Larger infarct area (estimated by serial cardiac markers)[1]
- Diabetes mellitus[1]
- Impaired fasting glucose[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.
- 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]
- In certain cases, excessive use of diuretics causing depletion of intravascular volume[11]
- Systolic blood pressure < 120 mm Hg[9][10]
- Sinus tachycardia[9][10]
- Heart rate < 60 bpm[12]
- Physical findings of hypoperfusion at time of diagnosis, such as altered state of consciousness or cold and clammy skin[13]
- Oliguria[13]
- Cardiogenic shock on admission[14]
- Timespan between symptom onset and when reperfusion is restored[15]
Specific Risk Factors
According to the etiology of the shock post-myocardial infarction, the different risk factors may have different importances in each cause:[16]
- Right Ventricular Infarction
- Younger age
- Generally no history of previous MI
- Generally single-vessel coronary disease
- Less likely anterior wall myocardial infarction
- Volume overloading[17][18]
- Acute Mitral Regurgitation
- Female gender
- Older age
- Diabetes mellitus
- Underlying cerebrovascular disease
- Common preexisting symptomatic coronary artery disease[19]
- Ventricular Septal Rupture
- Male gender[20]
- Mean age of presentation of 62.5 years[21]
- Common history of myocardial infarction[22][23]
- History of systemic hypertension prior to myocardial infarction[24]
- Free-Wall Rupture/Tamponade
- Female gender
- Age greater than 55 years[25][26]
- History of hypertension
- Larger infarct area
- Delayed or incomplete revascularization[24][27][28]
- No history of myocardial infarction[24][26]
- Single vessel coronary artery disease[24][26]
References
- ↑ 1.0 1.1 1.2 1.3 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.
- ↑ 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.
- ↑ Picard MH, Davidoff R, Sleeper LA, Mendes LA, Thompson CR, Dzavik V; et al. (2003). "Echocardiographic predictors of survival and response to early revascularization in cardiogenic shock". Circulation. 107 (2): 279–84. PMID 12538428.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Hasdai, David. (2002). Cardiogenic shock : diagnosis and treatmen. Totowa, N.J.: Humana Press. ISBN 1-58829-025-5.
- ↑ 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) - ↑ 13.0 13.1 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.
- ↑ Ortolani P, Marzocchi A, Marrozzini C, Palmerini T, Saia F, Serantoni C; et al. (2006). "Clinical impact of direct referral to primary percutaneous coronary intervention following pre-hospital diagnosis of ST-elevation myocardial infarction". Eur Heart J. 27 (13): 1550–7. doi:10.1093/eurheartj/ehl006. PMID 16707549.
- ↑ Ng, R.; Yeghiazarians, Y. (2011). "Post Myocardial Infarction Cardiogenic Shock: A Review of Current Therapies". Journal of Intensive Care Medicine. 28 (3): 151–165. doi:10.1177/0885066611411407. ISSN 0885-0666.
- ↑ Hasdai, David. (2002). Cardiogenic shock : diagnosis and treatmen. Totowa, N.J.: Humana Press. ISBN 1-58829-025-5.
- ↑ Brookes, C.; Ravn, H.; White, P.; Moeldrup, U.; Oldershaw, P.; Redington, A. (1999). "Acute Right Ventricular Dilatation in Response to Ischemia Significantly Impairs Left Ventricular Systolic Performance". Circulation. 100 (7): 761–767. doi:10.1161/01.CIR.100.7.761. ISSN 0009-7322.
- ↑ Tcheng JE, Jackman JD, Nelson CL, Gardner LH, Smith LR, Rankin JS; et al. (1992). "Outcome of patients sustaining acute ischemic mitral regurgitation during myocardial infarction". Ann Intern Med. 117 (1): 18–24. PMID 1596043.
- ↑ SANDERS RJ, KERN WH, BLOUNT SG (1956). "Perforation of the interventricular septum complicating myocardial infarction; a report of eight cases, one with cardiac catheterization". Am Heart J. 51 (5): 736–48. PMID 13302144.
- ↑ Skillington PD, Davies RH, Luff AJ, Williams JD, Dawkins KD, Conway N; et al. (1990). "Surgical treatment for infarct-related ventricular septal defects. Improved early results combined with analysis of late functional status". J Thorac Cardiovasc Surg. 99 (5): 798–808. PMID 2329817.
- ↑ Hutchins GM (1979). "Rupture of the interventricular septum complicating myocardial infarction: pathological analysis of 10 patients with clinically diagnosed perforations". Am Heart J. 97 (2): 165–73. PMID 760447.
- ↑ Daggett WM, Buckley MJ, Akins CW, Leinbach RC, Gold HK, Block PC; et al. (1982). "Improved results of surgical management of postinfarction ventricular septal rupture". Ann Surg. 196 (3): 269–77. PMC 1352596. PMID 7114934.
- ↑ 24.0 24.1 24.2 24.3 Mann JM, Roberts WC (1988). "Rupture of the left ventricular free wall during acute myocardial infarction: analysis of 138 necropsy patients and comparison with 50 necropsy patients with acute myocardial infarction without rupture". Am J Cardiol. 62 (13): 847–59. PMID 3052010.
- ↑ Bates RJ, Beutler S, Resnekov L, Anagnostopoulos CE (1977). "Cardiac rupture--challenge in diagnosis and management". Am J Cardiol. 40 (3): 429–37. PMID 331926.
- ↑ 26.0 26.1 26.2 Figueras J, Curos A, Cortadellas J, Sans M, Soler-Soler J (1995). "Relevance of electrocardiographic findings, heart failure, and infarct site in assessing risk and timing of left ventricular free wall rupture during acute myocardial infarction". Am J Cardiol. 76 (8): 543–7. PMID 7677073.
- ↑ Lewis AJ, Burchell HB, Titus JL (1969). "Clinical and pathologic features of postinfarction cardiac rupture". Am J Cardiol. 23 (1): 43–53. PMID 5380841.
- ↑ Dellborg M, Held P, Swedberg K, Vedin A (1985). "Rupture of the myocardium. Occurrence and risk factors". Br Heart J. 54 (1): 11–6. PMC 481840. PMID 4015910.