Abstract
Out of 481 patients with acute myocardial infarction, 50 patients complicated with cardiogenic shock were divided into two groups from the response to therapy: in 31 responders and 19 poor responders, and their clinical findings were comparatively evaluated. Age of the responder-and poor responder-group was 63.7±10.6 and 70.2±11.5 years old, respectively. No difference in the frequencies of myocardial infarction attacks was observed between two groups. In 12 leads ECG, the patterns of widespread infarction including anterior wall were seen in the poor responder group. On admission to the CCU, 27 of 50 patients (54%) were already in the shocked state, and the patients hospitalized within 3 hours from the incidence of myocardial infarction were observed in the poor responder group (25.0% vs., 63.6%, p<0.05) . For the degree of pulmonary congestion in shock, patients in the poor responder group were severe. There were no difference of heart rates and systolic blood pressure states between both groups, whereas lower hourly urinary output was observed in the poor responder group. For the comparison of hemodynamic indices obtained in the shocked states, CI, SVI and LVSWI in the poor responder group were significantly low, whereas PCWP showed significantly high values. There was no difference between both groups in the initial thera-peutic dosages of dopamine (DOA) or dobutamine (DOB), and the effective dosages of DOA or DOB used for 21 patients of the responder group, who were survived from the shocked states without IABP, were 10.6±6.2μg/kg/min. Therefore, it is considered the necessity of an immediate IABP, when the shocked state was not reversed by the administration of DOA or DOB at dosage of 10μg/kg/min.