Document Detail


Early coronary angioplasty for acute myocardial infarction complicated by cardiogenic shock: have novel therapies led to better results?
MedLine Citation:
PMID:  11103025     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Patients with acute myocardial infarction (MI) and cardiogenic shock constitute a very high risk subset despite an aggressive management. The objective of this study was to evaluate if the results of early coronary angioplasty in patients with acute myocardial infarction and cardiogenic shock have changed over the last years, and to address which role the recent adjuvant therapies have played in this evolution. From 1991 to April 1999, 94 patients with acute MI and cardiogenic shock were treated with coronary angioplasty within the first 12 hours from the onset of symptoms. Temporal changes of the utilization of adjuvant therapies and operators experience were studied over these years, as well as their impact on the angiographic results and in-hospital outcome. Over the years, a progressive and significant increase on the use of coronary stents and c7E3Fab was observed, as well as an increased number of primary angioplasties performed per month. The proportion of patients treated with intraaortic balloon pump did not changed significantly over the years. An angiographic successful result (< 50% residual stenosis and TIMI flow 2 or 3) and a final TIMI grade 3 flow were obtained in 76 (80.9%) and 61 (64.9%) patients, respectively. The angiographic success rate progressively increased over the years, from 72.3% in patients treated before 1994 to 94.1% in those admitted in 1998Eth 1999 (p for trend 0.0409). The proportion of patients with a final TIMI grade 3 flow also grew progressively over the years: from 36.4% before 1994 to 76.5% after 1997 (p for trend 0. 0209). The overall in-hospital mortality rate was 63.8% (60 patients), and there was no significant change in mortality rate over the years. Therefore, apart from the growing operators experience, we have observed an incremental change in the use of coronary stents and c7E3 Fab (abciximab) in patients with acute myocardial infarction and cardiogenic shock treated with early coronary angioplasty. All these factors have led to an improvement in the angiographic results, although this change has not meant a significant reduction of mortality.
Authors:
R Moreno; E Garcia; M Abeytua; J Soriano; J Acosta; L Perez De Isla; E Lopez De Sa; R Rubio; J Lopez-Sendon
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of invasive cardiology     Volume:  12     ISSN:  1042-3931     ISO Abbreviation:  J Invasive Cardiol     Publication Date:  2000 Dec 
Date Detail:
Created Date:  2001-01-12     Completed Date:  2001-02-15     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8917477     Medline TA:  J Invasive Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  597-604     Citation Subset:  IM    
Affiliation:
Division of Interventional Cardiology, Hospital Gregorio Maranon, Doctor Esquerdo, 46, 28007, Madrid, Spain.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Angioplasty, Transluminal, Percutaneous Coronary*
Female
Hospital Mortality
Humans
Male
Middle Aged
Myocardial Infarction / mortality,  therapy*
Outcome and Process Assessment (Health Care)
Retrospective Studies
Shock, Cardiogenic / mortality,  therapy*
Spain
Stents
Survival Analysis
Time Factors

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


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