Background
Cardiogenic shock (CS) is one of the most important causes of death in patients hospitalized in coronary care units. The primary aim was to evaluate the predictive effect of beta-blockade (iv or po), initiated early in the treatment of patient who developed CS either before admission or at any time during the hospitalization, on 30-day mortality. The secondary aim was to evaluate the prognostic value of other frequently used (prehospital and in-hospital) therapeutic interventions on 30-day mortality in CS patients.
Methods
Data were obtained prospectively from RIKS-HIA (Register of Information and Knowledge about Swedish Heart Intensive Care Admission) about 829 consecutive patients (between 2003 and2008) with CS hospitalized at Sahlgrenska University Hospital and University Hospital in Lund. Predictors of 30-day mortality were analyzed using propensity score (PS) model. The PS was calculated (by means of logistic regression) using prespecified variables, i.e., age, gender, diabetes, hypertension, smoking, ST-elevation myocardial infarction (MI), non-ST-elevation MI, previous MI, previous coronary artery bypass surgery, previous heart failure, previous percutaneous coronary intervention and previous stroke. The PS was then included in the multivariable logistic regression model for prediction of 30-day mortality together with the following variables that reflect prehospital and in-hospital therapeutic interventions: treatment with (a) beta-blockers, (b) unfractionated heparin and low-molecular-weight heparins, (c) diuretics, (d) inotropes, (e) glycoprotein IIb/IIIa receptor antagonists, (f) nitrovasodilators and (g) intraaortic balloon counter-pulsation (IABP).
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