| Early revascularization and long-term survival in cardiogenic shock complicating acute myocardial infarction. | |
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MedLine Citation:
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PMID: 16757723 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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CONTEXT: Cardiogenic shock remains the major cause of death for patients hospitalized with acute myocardial infarction (MI). Although survival in patients with cardiogenic shock complicating acute MI has been shown to be significantly higher at 1 year in those receiving early revascularization vs initial medical stabilization, data demonstrating long-term survival are lacking. OBJECTIVE: To determine if early revascularization affects long-term survival of patients with cardiogenic shock complicating acute MI. DESIGN, SETTING, AND PATIENTS: The Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial, an international randomized clinical trial enrolling 302 patients from April 1993 through November 1998 with acute myocardial infarction complicated by cardiogenic shock (mean [SD] age at randomization, 66 [11] years); long-term follow-up of vital status, conducted annually until 2005, ranged from 1 to 11 years (median for survivors, 6 years). MAIN OUTCOME MEASURES: All-cause mortality during long-term follow-up. RESULTS: The group difference in survival of 13 absolute percentage points at 1 year favoring those assigned to early revascularization remained stable at 3 and 6 years (13.1% and 13.2%, respectively; hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.57-0.97; log-rank P = .03). At 6 years, overall survival rates were 32.8% and 19.6% in the early revascularization and initial medical stabilization groups, respectively. Among the 143 hospital survivors, a group difference in survival also was observed (HR, 0.59; 95% CI, 0.36-0.95; P = .03). The 6-year survival rates for the hospital survivors were 62.4% vs 44.4% for the early revascularization and initial medical stabilization groups, respectively, with annualized death rates of 8.3% vs 14.3% and, for the 1-year survivors, 8.0% vs 10.7%. There was no significant interaction between any subgroup and treatment effect. CONCLUSIONS: In this randomized trial, almost two thirds of hospital survivors with cardiogenic shock who were treated with early revascularization were alive 6 years later. A strategy of early revascularization resulted in a 13.2% absolute and a 67% relative improvement in 6-year survival compared with initial medical stabilization. Early revascularization should be used for patients with acute MI complicated by cardiogenic shock due to left ventricular failure. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00000552. |
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Authors:
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Judith S Hochman; Lynn A Sleeper; John G Webb; Vladimir Dzavik; Christopher E Buller; Philip Aylward; Jacques Col; Harvey D White; |
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Publication Detail:
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Type: Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural |
Journal Detail:
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Title: JAMA : the journal of the American Medical Association Volume: 295 ISSN: 1538-3598 ISO Abbreviation: JAMA Publication Date: 2006 Jun |
Date Detail:
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Created Date: 2006-06-07 Completed Date: 2006-06-12 Revised Date: 2011-05-05 |
Medline Journal Info:
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Nlm Unique ID: 7501160 Medline TA: JAMA Country: United States |
Other Details:
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Languages: eng Pagination: 2511-5 Citation Subset: AIM; IM |
Affiliation:
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Cardiovascular Clinical Research Center, New York University School of Medicine, New York 10016, USA. judith.hochman@med.nyu.edu |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00000552 |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Angioplasty, Balloon, Coronary Coronary Artery Bypass Female Follow-Up Studies Humans Male Middle Aged Myocardial Infarction Myocardial Revascularization* Shock, Cardiogenic / mortality, therapy* Survival Analysis Survivors Thrombolytic Therapy |
| Grant Support | |
ID/Acronym/Agency:
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R01 HL050020-05/HL/NHLBI NIH HHS; R01 HL50020/HL/NHLBI NIH HHS; R01-HL49970/HL/NHLBI NIH HHS |
| Comments/Corrections | |
Comment In:
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ACP J Club. 2006 Nov-Dec;145(3):59
[PMID:
17080971
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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