| Cardiogenic shock: thrombolysis or angioplasty? | |
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MedLine Citation:
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PMID: 10160069 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Cardiogenic shock (CGS) occurs in 3 to 20% of patients presenting with acute myocardial infarction (MI), and it generally involves dysfunction of at least 40% of the total myocardial mass. Prior to the advent of balloon angioplasty and thrombolysis, in-hospital mortality was greater than 75%. This mortality rate has been consistent in reported series despite the advent of cardiac intensive care units, vasopressor, inotropic, and vasodilator therapy. Intra-aortic balloon counterpulsation therapy provides hemodynamic improvement, and it may provide some mortality benefit when used in conjunction with appropriate revascularization. Survival studies have shown that patency of the infarct-related artery is a strong predictor of survival. No randomized trials have been completed to examine which reperfusion therapy best treats this emergent situation. Subgroup analysis of large scale, multicenter trials, although underpowered, has shown no improvement in mortality with use of thrombolytic agents, leading many to advise use of mechanical intervention. In patients who present with acute MI with contraindications to thrombolysis, primary angioplasty is the treatment of choice. At selected centers, primary angioplasty is comparable to or better than thrombolytic therapy for patients presenting with acute MI, with or without CGS. Studies examining angioplasty in patients with CGS have shown high procedural success rates (75%) and reduced in-hospital mortality (44%), particularly in those patients with successful revascularization. Emergency bypass surgery may improve survival, but it is costly, unavailable to many, and often leads to excessive delays in therapy. If available, we believe that primary angioplasty is the treatment of choice for patients with CGS. |
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Authors:
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T M Chou; T M Amidon; T A Ports; C L Wolfe |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.; Review |
Journal Detail:
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Title: Journal of intensive care medicine Volume: 11 ISSN: 0885-0666 ISO Abbreviation: J Intensive Care Med Publication Date: 1996 Jan-Feb |
Date Detail:
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Created Date: 1996-10-10 Completed Date: 1996-10-10 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 8610344 Medline TA: J Intensive Care Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 37-48 Citation Subset: T |
Affiliation:
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The Adult Cardiac Catheterization Laboratories, Cardiology Division and Cardiovascular Research Institute, Henry Moffitt-Joseph Long Hospitals, University of California, San Francisco, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Angioplasty, Balloon*
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instrumentation,
methods Counterpulsation Humans Myocardial Infarction / complications* Prognosis Shock, Cardiogenic / diagnosis, epidemiology, etiology, physiopathology, therapy* Thrombolytic Therapy* Treatment Outcome |
| Grant Support | |
ID/Acronym/Agency:
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F32 HL090969-01/HL/NHLBI NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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