| Improved survival after acute myocardial infarction complicated by cardiogenic shock with circulatory support and transplantation: comparing aggressive intervention with conservative treatment. | |
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MedLine Citation:
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PMID: 16678027 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The prognosis for patients with myocardial infarction has steadily improved, but remains poor for those developing cardiogenic shock. Utilization of re-vascularization, mechanical circulatory support and transplantation in these patients may improve survival. METHODS: We retrospectively analyzed the clinical outcome of 138 consecutive patients at the Cleveland Clinic from 1992 to 1998 who met the criteria for cardiogenic shock after acute myocardial infarction. All patients received intensive medical therapy and intra-aortic balloon pump support. Forty-three patients received intensive medical therapy (conservative group) and 95 patients were treated aggressively (aggressive group). The aggressive group comprised patients who were treated with percutaneous intervention/coronary artery bypass grafting (n = 77, re-vascularization group), and patients who received circulatory support/cardiac transplantation (n = 18). RESULTS: The baseline demographics and angiographic and hemodynamic features were comparable for the two groups. The in-hospital mortality rate was significantly reduced in the aggressive group compared with the conservative group (54% vs 81%, p = 0.002). The in-hospital mortality rate of the circulatory support/transplant group was markedly reduced compared with the conservative group (33% vs 81%, p < 0.001), and was also significantly lower than that of the re-vascularization group (33% vs 63%, p= 0.03). The aggressive group had a markedly improved 5-year survival compared with the conservative group (30% vs 6.2%, p = 0.003). CONCLUSIONS: These data suggest that an aggressive strategy, particularly left ventricular assist device support as a bridge to heart transplantation, may improve survival in post-myocardial infarction patients with cardiogenic shock. |
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Authors:
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Wakkas Tayara; Randall C Starling; Mohamad H Yamani; Oussama Wazni; Fuad Jubran; Nicholas Smedira |
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Publication Detail:
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Type: Comparative Study; Journal Article Date: 2006-03-30 |
Journal Detail:
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Title: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation Volume: 25 ISSN: 1557-3117 ISO Abbreviation: J. Heart Lung Transplant. Publication Date: 2006 May |
Date Detail:
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Created Date: 2006-05-08 Completed Date: 2006-07-18 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 9102703 Medline TA: J Heart Lung Transplant Country: United States |
Other Details:
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Languages: eng Pagination: 504-9 Citation Subset: IM |
Affiliation:
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Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. |
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Angioplasty, Transluminal, Percutaneous Coronary Coronary Artery Bypass Extracorporeal Circulation* Extracorporeal Membrane Oxygenation Female Heart Transplantation* Hospital Mortality Humans Male Middle Aged Retrospective Studies Shock, Cardiogenic / drug therapy, mortality*, surgery, therapy Survival Analysis Thrombolytic Therapy |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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