Jump to
Figures
Figure 1. Kaplan-Meier estimates of survival up to 1 year after randomization for 4 combinations of LVEF and MR (log-rank test P=0.0001). Total n=90; MR 0/1 and LVEF ≥28%, n= 33; MR 0/1 and LVEF <28%, n= 20; MR 2/3/4 and LVEF ≥28%, n= 16; MR 2/3/4 and LVEF <28%, n= 21.
Figure 2. Estimated 1-year survival by treatment assignment. LVEF measured within 24 hours of randomization (before any revascularization attempt) is significantly associated with 1-year survival (P=0.025). Tick marks at top and bottom of plot indicate raw data values for ERV and IMS groups, respectively.
Figure 3. Association between MR grade, treatment assignment, and 1-year survival.
Tables
TABLE 1. Characteristics of Trial Patients With Early Echocardiograms
ERV (n=82) IMS (n=87) Age, y 65±10 65±12 Male, % 70 76 Transfer admission, % 62 64 Median time, h MI to shock 4.9 5.0 MI to randomization 10.8 12.1 Randomization to echocardiogram 0.2 0.6 Prior MI, % 29 35 History of hypertension, % 49 42 Diabetes, % 43 20 History of congestive heart failure, % 3.8 4.8 Renal insufficiency, % 9.6 4.9 Prior CABG, % 1.2 9.2 Prior PTCA, % 1.0 4.7 TABLE 2. Clinical Characteristics of Patients With Early Echocardiograms
ERV (n=82) IMS (n=87) *Often obtained while patient was receiving supportive measures. Anterior index MI, % 65 54 Multiple MI locations on ECG, % 53 57 Median creatine kinase, IU/L 3228 4000 Lowest prerandomization systolic blood pressure, mm Hg 68±15 70±10 Systolic blood pressure, mm Hg* 91±24 88±18 Heart rate, bpm 100±22 97±23 Pulmonary capillary wedge pressure, mm Hg* 25±7 23±7 Cardiac index, L · min−1 · m−2* 2.0±0.8 1.8±0.5 Left main coronary artery disease, % 20.5 13.3 No. of diseased vessels, % n=79 n=60 ≤1 13.9 13.3 2 21.5 28.3 3 64.6 58.3 TABLE 3. Baseline Echocardiographic Findings
Total (n=140)* ERV (n=53) IMS (n=87) WMS indicates wall-motion score. *Minimum total sample size=95 because of parameters that could not be assessed. P=0.004 for LV thrombus; no other findings in table differed significantly by treatment assignment. LV end-diastolic volume, mL 114±43 123±48 109±39 LV end-systolic volume, mL 81±36 87±39 77±34 LVEF, % 30.6±11.3 30.4±12.1 30.7±10.9 Diastolic sphericity index 0.50±0.09 0.51±0.09 0.49±0.09 Systolic sphericity index 0.46±0.11 0.46±0.10 0.46±0.11 RV area change, % 33.1±14.5 34.3±13.4 32.2±15.3 LV thrombus, % 16.8 2.8 25.4 MR grade 1.3±0.9 1.4±0.9 1.3±1.0 MR <2, % 60.9 59.1 62.0 MR ≥2, % 39.1 40.9 38.0 Total WMS 37.5±11.2 38.4±9.8 36.9±12.1 WMS index (total/No. of segments) 2.1±0.4 2.2±0.5 2.1±0.4 WMS index, infarct zone 2.6±0.3 2.6±0.3 2.6±0.3 WMS index, remote zone 0.9±0.3 0.9±0.3 0.9±0.3 Remote zone hyperkinesis, % 36.6 31.7 39.4 TABLE 4. Univariate Predictors of 1-Year Survival
n Dead Alive Odds Ratio (95% CI) P *Per 20-mL increase. †Per 5% increase. End-diastolic volume, mL 100 122±42 103±43 1.26* (1.02, 1.54) 0.029 End-systolic volume, mL 99 88±34 70±36 1.38* (1.08, 1.78) 0.012 LVEF, % 99 28±11 34±11 0.79† (0.65, 0.96) 0.015 MR <2 vs ≥2 114 2/3/4 MR: 31% survival 0/1 MR: 58% survival 3.05 (1.38, 6.74) 0.006 LVEF <28% 99 <28%, 24% survival ≥28%, 56% survival 3.86 (1.63, 9.19) 0.002
This Issue
Jump to
Article Tools
Share this Article
- Echocardiographic Predictors of Survival and Response to Early Revascularization in Cardiogenic ShockPermalink:
