Cardiogenic Shock: A Summary of the Randomized SHOCK Trial

Venu Menon, MD, Rupert Fincke, MD

Disclosures

CHF. 2003;9(1) 

In This Article

Timing of Shock

CS may present as an early complication following ST elevation and MI. In the SHOCK trial, the median time from MI to shock onset was 5.0 hours (25th to 75th percentile, 2.2-12.0 hours) in the ERV group and 6.2 hours (2.4-15.5 hours) in the IMS group. Similarly, in the SHOCK registry it was 7.0 hours (1.8-2.2 hours). This is in contrast to the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO)-1 thrombolytic megatrial, in which a majority of patients developed CS later, after randomization.[1] Although GUSTO-1 did not exclude patients with CS, this disparity in timing reflects the selective nature of patients entering thrombolytic trials. Site investigators in thrombolytic trials may not consider patients who are moribund at admission or at high risk for early death. Consequently, the recorded timing of shock may be skewed in these studies.

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