6/29/23, 11:42 PM SHOCK Pathway Feedback Search Clinical Topics Home Studies SHOCK SHOCK Disease Disease Cardiogenic shock ST-elevation myocardial infarction Trial question What is the effect of emergency revascularization in patients with shock due to LV failure complicating myocardial infarction? Study design Multi-center Open label RCT Population Characteristics of study participants 32.0% female N = 302 68.0% male 302 patients (97 female, 205 male) Inclusion criteria: patients with shock due to LV failure complicating myocardial infarction Key exclusion criteria: severe systemic illness, mechanical or other cause of shock, severe valvular disease, dilated cardiomyopathy, and unsuitability for revascularization Interventions N=152 emergency revascularization (CABG or angioplasty within 6 hours of randomization, intraaortic balloon counterpulsation recommended) N=150 initial medical stabilization (intensive medical treatment, intraaortic balloon counterpulsation recommended) https://web.pathway.md/studies/recIASDj4i32ml4we 1/2 6/29/23, 11:42 PM SHOCK Pathway Primary outcome Death at 30 days 56.0 % 56 46.7 42.0 % 28.0 % 14.0 % No significant difference 0.0 % Emergency revascularization Initial medical stabilization No significant difference in death at 30 days (46.7% vs. 56%; RR 0.83, 95% CI 0.67 to 1.04) Secondary outcomes Significant decrease in death at 6 months (50.3% vs. 63.1%; RR 0.8, 95% CI 0.65 to 0.98) Safety outcomes No significant difference in adverse events. Significant difference in acute renal failure (13% vs. 24%). Conclusion In patients with shock due to LV failure complicating myocardial infarction, emergency revascularization was not superior to initial medical stabilization with respect to death at 30 days. Reference Hochman JS, Sleeper LA, Webb JG et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med. 1999 Aug 26;341(9):625-34. Open reference URL https://web.pathway.md/studies/recIASDj4i32ml4we 2/2