| Cardiogenic shock due to acute severe mitral regurgitation complicating acute myocardial infarction: a report from the SHOCK Trial Registry. SHould we use emergently revascularize Occluded Coronaries in cardiogenic shocK? | |
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MedLine Citation:
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PMID: 10985712 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: Our objective was to define the outcomes of patients with cardiogenic shock (CS) due to severe mitral regurgitation (MR) complicating acute myocardial infarction (AMI). BACKGROUND: Methods for early identification and optimal treatment of such patients have not been defined. METHODS: The SHOCK Trial Registry enrolled 1,190 patients with CS complicating AMI. We compared 1) the cohort with severe mitral regurgitation (MR, n = 98) to the cohort with predominant left ventricular failure (LVF, n = 879), and 2) the MR patients who underwent valve surgery (n = 43) to those who did not (n = 51). RESULTS: Shock developed early after MI in both the MR (median 12.8 h) and LVF (median 6.2 h) cohorts. The MR patients were more often female (52% vs. 37%, p = 0.004) and less likely to have ST elevation at shock diagnosis (41% vs. 63%, p < 0.001). The MR index MI was more frequently inferior (55% vs. 44%, p = 0.039) or posterior (32% vs. 17%, p = 0.002) than that of LVF and much less frequently anterior (34% vs. 59%, p < 0.001). Despite having higher mean LVEF (0.37 vs. 0.30, p = 0.001) the MR cohort had similar in-hospital mortality (55% vs. 61%, p = 0.277). The majority of MR patients did not undergo mitral valve surgery. Those undergoing surgery exhibited higher mean LVEF than those not undergoing surgery; nevertheless, 39% died in hospital. CONCLUSIONS: The data highlight opportunities for early identification and intervention to potentially decrease the devastating mortality and morbidity of severe post-myocardial infarction MR. |
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Authors:
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C R Thompson; C E Buller; L A Sleeper; T A Antonelli; J G Webb; W A Jaber; J G Abel; J S Hochman |
Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 36 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2000 Sep |
Date Detail:
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Created Date: 2000-09-26 Completed Date: 2000-09-26 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1104-9 Citation Subset: AIM; IM |
Affiliation:
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Division of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada. cthompson@Providencehealth.bc.ca |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Balloon Dilatation Coronary Angiography Female Heart Valve Prosthesis Implantation Hospital Mortality Humans Male Middle Aged Mitral Valve Insufficiency / complications*, physiopathology, therapy Myocardial Infarction / complications, physiopathology, radiography, therapy Myocardial Revascularization Odds Ratio Prospective Studies Registries* Shock, Cardiogenic / etiology*, mortality, physiopathology, therapy Stroke Volume Survival Rate |
| Grant Support | |
ID/Acronym/Agency:
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HL 50020-018Z/HL/NHLBI NIH HHS; HL-49970/HL/NHLBI NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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