Frequency and clinical outcome of cardiogenic shock during acute myocardial infarction among patients receiving reteplase or alteplase. Results from GUSTO-III

Abstract

Aims Reteplase has been reported to achieve better patency of the infarct artery than alteplase. As infarct artery patency is strongly associated with survival among patients with cardiogenic shock, we postulated that treatment with reteplase would improve outcomes among shock patients. MethodsWe compared 30-day mortality rates among patients in GUSTO-III who either presented with shock or developed shock after enrolment; all patients received either front-loaded alteplase or reteplase (two bolus doses of 10 MU, 30 min apart).Results Shock occurred in 260 (5·3%) of 4921 patients randomized to alteplase and 560 (5·5%) of 10 138 patients randomized to reteplase. Of these patients, 28 (10·8%) and 55 (9·8%) randomized to alteplase and reteplase, respectively, presented with shock. In-hospital, 35% and 37% of shock patients assigned to alteplase or reteplase, respectively, underwent coronary angiography, with similar rates of percutaneous (11-13%) or surgical (2-3%) revascularization procedures subsequently performed. Death within 30 days occurred in 169 (65%) and 353 (63%) shock patients randomized to alteplase and reteplase, respectively (P=0·59). Of patients presenting with shock, 64% and 58% of patients randomized to alteplase or reteplase died within 30 days (P=0·59). ConclusionCompared with alteplase, reteplase did not improve outcome among patients who presented with shock or developed shock after receiving thrombolytics. The newer-generation thrombolytic agents remain of limited efficacy in the treatment and prevention of shock. (Eur Heart J 1999; 20: 128-135)

Cardiogenic Shock: Single Center Experience with and without On-Site Catheterization Facilities

“…These discouraging findings regarding the limitation of reperfusion therapy in cardiogenic shock patients are also supported by two of the most recent studies from GUSTO-III investigators [11]and Perez-Castellano et al [12]. Thus, it is possible that beyond a certain ‘therapeutic window’, revascularization is ineffective, possibly because of extensive metabolic insult or reperfusion injury to the myocardium.…”

Predictive Factors of Major Adverse Cardiac Events in Acute Myocardial Infarction Patients Complicated by Cardiogenic Shock Undergoing Primary Percutaneous Coronary Intervention

“…[20][21][22] Elevated CRP concentration is associated with a poor prognosis in ACS. [23][24][25] We previously reported that a high CRP concentration is related to a poor prognosis in patients with AMI and poor long-term clinical outcomes after primary or rescue PCI.…”

Impact of Time to Treatment on Mortality After Prehospital Fibrinolysis or Primary Angioplasty

“…In these patients, primary PCI may be a better option in terms of survival than thrombolysis. [27][28][29] Finally, in the present study, treatment was initiated in a prehospital setting, which may not be feasible in all environments. Whether these results apply to in-hospital thrombolysis for patients treated early during the course of their symptoms is uncertain.…”