Document Detail

Cardiogenic shock complicating acute myocardial infarction: the use of coronary angioplasty and the integration of the new support devices into patient management.
MedLine Citation:
PMID:  1538023     Owner:  NLM     Status:  MEDLINE    
Conventional therapy for cardiogenic shock complicating acute myocardial infarction continues to be associated with a high in-hospital mortality rate. Hemodynamic support with new mechanical devices and emergency coronary revascularization may alter the long-term prognosis for patients with this complication. Between July 1985 and March 1990, 68 patients presented to the University of Michigan with acute myocardial infarction and cardiogenic shock. Interventions performed included thrombolytic therapy (46%), intraaortic balloon pump counterpulsation (70%), cardiac catheterization (86%), coronary angioplasty (73%), emergency coronary artery bypass grafting/ventricular septal defect repair (15%), Hemopump insertion (11%), percutaneous cardiopulmonary support (4%) and ventricular assist device (3%). The 30-day survival rate was significantly better in patients who had successful angioplasty of the infarct-related artery than in patients with failed angioplasty (61% vs. 7%, p = 0.002) or no attempt at angioplasty (61% vs. 14%, p = 0.003). This difference was maintained over the 1-year follow-up period. The only clinical variable that predicted survival was age less than 65 years. The early use of the new support devices in 10 patients was associated with death in 8 (80%), but this poor outcome may reflect a selection bias for an especially high risk population. Collectively, these recent data continue to suggest that emergency revascularization with angioplasty may reduce the mortality rate, but further study is required to define optimal utilization and integration of new support devices.
G M Gacioch; S G Ellis; L Lee; E R Bates; M Kirsh; J A Walton; E J Topol
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  19     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1992 Mar 
Date Detail:
Created Date:  1992-03-31     Completed Date:  1992-03-31     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  647-53     Citation Subset:  AIM; IM    
Department of Medicine, University of Michigan, Ann Arbor.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary*
Coronary Artery Bypass
Heart-Assist Devices*
Middle Aged
Myocardial Infarction / complications*,  mortality,  therapy
Shock, Cardiogenic / etiology,  mortality,  therapy*
Survival Rate
Treatment Outcome
Comment In:
J Am Coll Cardiol. 1992 Mar 1;19(3):654-6   [PMID:  1538024 ]

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