- Question
- Does emergency revascularization improve survival, compared with initial medical stabilization, in patients with cardiogenic shock due to left ventricular failure complicating acute myocardial infarction?
- Design
- Randomized trial assigning patients to emergency revascularization (152 patients) or initial medical stabilization (150 patients). Fifty-five percent of patients were transferred from other hospitals.
- Population
- Patients with shock due to left ventricular failure complicating myocardial infarction; mean age 66±10 years, 32 percent women, median time to onset of shock 5.6 hours after infarction, and mostly anterior infarcts.
- Intervention
- Emergency revascularization by coronary-artery bypass grafting or angioplasty. Ninety-seven percent of those assigned to this group underwent early coronary angiography and 87 percent underwent revascularization.
- Control
- Initial medical stabilization; only 2.7 percent of this group crossed over to early revascularization without clinical indication. Intraaortic balloon counterpulsation was used in 86 percent of patients in both groups.
- Primary outcome
- All-cause mortality at 30 days; six-month survival was a secondary end point.
- Results
- Mortality at 30 days did not differ significantly between revascularization and medical therapy (46.7 percent vs. 56.0 percent; difference, -9.3 percent; 95 percent CI for the difference, -20.5 to 1.9 percent; P=0.11). At six months, mortality was lower with revascularization (50.3 percent vs. 63.1 percent, P=0.027).
- Conclusion
- Emergency revascularization did not significantly reduce overall 30-day mortality, but showed a significant survival benefit at six months.
- Why it matters
- It established early revascularization as a strategy to be strongly considered in myocardial infarction complicated by cardiogenic shock, changing the therapeutic approach to this high-mortality condition.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Some figures could not be verified automatically and were left out of this card.
Generated on October 18, 2026