Document Detail

Ischemia, reperfusion, and the role of surgery in the treatment of cardiogenic shock secondary to acute myocardial infarction: an interpretative review.
MedLine Citation:
PMID:  15013709     Owner:  NLM     Status:  MEDLINE    
Cardiogenic shock (CS) is the leading cause of death for patients hospitalized with acute myocardial infarction (AMI). Despite contemporary management of AMI, the incidence of shock due to left ventricular failure has not declined and its mortality continues to be in excess of 50%. Furthermore, the role and indications of the different means of acute revascularization remain unclear. Recent observational and randomized studies have shown improved survival in patients acutely revascularized by either percutaneous interventions or conventional surgery, particularly in patients younger than 75 years of age. Current guidelines recommend surgical revascularization in selected patients with multiple vessel disease who develop shock due to progressive ischemia of the remote myocardium up to 18 h from the onset of shock. However, patients with single-vessel disease who develop shock as a consequence of the initial infarction can only be helped if revascularization is achieved during the first 4 to 6 h after the occlusion of the infarct related artery, preferable by percutaneous techniques. Not all ischemic myocytes become irreversibly injured at the same time. Due to variability in the distribution of collateral flow, there is great variability in the severity of ischemia. Myocytes can exhibit different metabolic responses including hibernation, ischemic preconditioning, stunning, reperfusion injury, and necrosis. Precise knowledge of these biochemical and metabolic changes that take place in the myocardium after arterial occlusion and following reperfusion is paramount to the understanding of the indications for acute revascularization, the implementation of the different management strategies to enhance myocardial preservation and recovery, and the role of circulatory support in these exceedingly sick patients.
Jorge A Wernly
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  The Journal of surgical research     Volume:  117     ISSN:  0022-4804     ISO Abbreviation:  J. Surg. Res.     Publication Date:  2004 Mar 
Date Detail:
Created Date:  2004-03-11     Completed Date:  2004-05-25     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  0376340     Medline TA:  J Surg Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  6-21     Citation Subset:  IM    
The University of New Mexico, Health Sciences Center, Thoracic and Cardiovascular Surgery, Division of Cardiothoracic Surgery, MSC 10-5610, 1 University of New Mexico, Albuquerque, New Mexico 87131, USA.
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MeSH Terms
Myocardial Infarction / complications*
Myocardial Ischemia / physiopathology*,  surgery
Myocardial Reperfusion / adverse effects,  methods*
Reperfusion Injury / etiology,  physiopathology*
Shock, Cardiogenic / etiology,  physiopathology*,  surgery
Ventricular Dysfunction, Left / etiology,  physiopathology,  surgery

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