Document Detail


Comparison of late survival in patients with cardiogenic shock due to right ventricular infarction versus left ventricular pump failure following primary percutaneous coronary intervention for ST-elevation acute myocardial infarction.
MedLine Citation:
PMID:  17293178     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
This study compared late survival after primary percutaneous coronary intervention (PCI) in patients with cardiogenic shock due to right ventricular (RV) infarction versus left ventricular (LV) pump failure. Consecutive patients with ST-elevation myocardial infarction treated with primary PCI (n = 2,496) were prospectively enrolled in a registry from 1984 to 2004. Cardiogenic shock occurred before PCI in 189 patients (7.6%). Shock was attributed to predominant RV infarction when there was right coronary artery occlusion with preserved LV function and increased right atrial pressure. Patients with shock due to RV infarction (n = 30) versus LV pump failure (n = 136) had fewer previous infarctions (10% vs 29%, p = 0.03), less multivessel disease (20% vs 47%, p = 0.007), higher right atrial pressure (21 vs 16 mm, p = 0.003), and better LV ejection fraction (57% vs 32%, p <0.001). In-hospital mortality was lower with shock due to RV infarction (23% vs 50%, p = 0.01), and shock due to RV infarction was a significant independent predictor of late cardiac survival (hazard ratio 0.28, 95% confidence interval 0.13 to 0.62, p = 0.002). In conclusion, survival after primary PCI in patients with shock due to RV infarction is better than that in patients with shock due to LV pump failure. This is in contrast to most previous reports. Improved survival is likely related to lower risk profile and previously documented substantial recovery of RV function after primary PCI.
Authors:
Bruce R Brodie; Thomas D Stuckey; Charles Hansen; Barbara H Bradshaw; William E Downey; Mark W Pulsipher
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2006-12-20
Journal Detail:
Title:  The American journal of cardiology     Volume:  99     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2007 Feb 
Date Detail:
Created Date:  2007-02-12     Completed Date:  2007-04-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  431-5     Citation Subset:  AIM; IM    
Affiliation:
LeBauer Cardiovascular Research Foundation and Moses Cone Heart and Vascular Center, Greensboro, North Carolina, USA. bbrodie@triad.rr.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Transluminal, Percutaneous Coronary*
Chi-Square Distribution
Female
Hospital Mortality
Humans
Male
Middle Aged
Myocardial Infarction / complications*,  mortality,  physiopathology,  therapy*
Proportional Hazards Models
Prospective Studies
Registries
Risk Factors
Shock, Cardiogenic / etiology*,  mortality,  physiopathology
Survival Rate
Ventricular Dysfunction, Left / etiology*,  mortality,  physiopathology
Ventricular Dysfunction, Right / complications*,  mortality,  physiopathology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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