Predictors of cardiogenic shock after thrombolytic therapy for acute myocardial infarction

J Am Coll Cardiol. 2000 Jan;35(1):136-43. doi: 10.1016/s0735-1097(99)00508-2.


Objectives: This study characterized clinical factors predictive of cardiogenic shock developing after thrombolytic therapy for acute myocardial infarction (AMI).

Background: Cardiogenic shock remains a common and ominous complication of AMI. By identifying patients at risk of developing shock, preventive measures may be implemented to avert its development.

Methods: We analyzed baseline variables associated with the development of shock after thrombolytic therapy in the Global Utilization of Streptikonase and Tissue-Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I) trial. Using a Cox proportional hazards model, we devised a scoring system predicting the risk of shock. This model was then validated in the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO-III) cohort.

Results: Shock developed in 1,889 patients a median of 11.6 h after enrollment. The major factors associated with increased adjusted risk of shock were age (chi2 = 285, hazard ratio [95% confidence interval] 1.47 [1.40, 1.53]), systolic blood pressure (chi2 = 280), heart rate (chi2 = 225) and Killip class (chi2 = 161, hazard ratio 1.70 [1.52, 1.90] and 2.95 [2.39, 3.63] for Killip II versus I and Killip III versus I, respectively) upon presentation. Together, these four variables accounted for >85% of the predictive information. These findings were transformed into an algorithm with a validated concordance index of 0.758. Applied to the GUSTO-III cohort, the four variables accounted for > 95% of the predictive information, and the validated concordance index was 0.796.

Conclusions: A scoring system accurately predicts the risk of shock after thrombolytic therapy for AMI based primarily on the patient's age and physical examination on presentation.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Algorithms
  • Drug Therapy, Combination
  • Female
  • Heparin / administration & dosage
  • Heparin / adverse effects
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / drug therapy*
  • Prognosis
  • Proportional Hazards Models
  • Risk Factors
  • Shock, Cardiogenic / etiology*
  • Shock, Cardiogenic / prevention & control
  • Streptokinase / administration & dosage*
  • Streptokinase / adverse effects
  • Thrombolytic Therapy*
  • Tissue Plasminogen Activator / administration & dosage*
  • Tissue Plasminogen Activator / adverse effects


  • Heparin
  • Streptokinase
  • Tissue Plasminogen Activator