| Prognosis and management of anterolateral myocardial infarction in patients with severe left main disease and cardiogenic shock. The left main shock syndrome. | |
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MedLine Citation:
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PMID: 8222198 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: To identify the determinants of survival in patients with severe (> 75%) stenosis of the left main coronary artery (LM) and an acute (48 hours) anterolateral myocardial infarction (AAMI), we retrospectively analyzed the course of 34 such patients who presented to our institution over the last decade. METHODS AND RESULTS: LM disease was diagnosed arteriographically at presentation, and AAMI was determined by ECG, enzymatic, and kinetic criteria. Of the nine patients (26%) managed medically, seven patients (78%) were in cardiogenic shock (cardiac index < 2.0, left ventricular end-diastolic pressure > 25, and pulmonary edema), and all seven died in hospital. Twenty-five (74%) of the 34 patients were managed surgically or with angioplasty. Nine of these patients, of whom eight were in cardiogenic shock, also died in hospital. Regardless of the method of treatment, the presence of cardiogenic shock in this population was reproducibly a grave prognostic indicator. That is, 15 (94%) of the 16 patients in cardiogenic shock at presentation died in hospital, and only 1 (5%) of the 18 patients without cardiogenic shock died (P < .001). CONCLUSIONS: Thus, we propose that, because patients presenting with AAMI, severe LM stenosis, and cardiogenic shock (left main shock syndrome) have such a grave prognosis regardless of management, conservative measures may be indicated. |
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Authors:
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R L Quigley; C A Milano; L R Smith; W D White; J S Rankin; D D Glower |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Circulation Volume: 88 ISSN: 0009-7322 ISO Abbreviation: Circulation Publication Date: 1993 Nov |
Date Detail:
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Created Date: 1993-11-29 Completed Date: 1993-11-29 Revised Date: 2010-03-24 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: II65-70 Citation Subset: AIM; IM |
Affiliation:
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Department of Surgery, Duke University Medical Center, Durham, NC 27710. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Angioplasty, Transluminal, Percutaneous Coronary Coronary Artery Bypass Coronary Disease / mortality*, therapy Female Follow-Up Studies Hospital Mortality Humans Male Multivariate Analysis Myocardial Infarction / mortality*, therapy Prognosis Retrospective Studies Risk Factors Shock, Cardiogenic / mortality*, therapy Survival Analysis Time Factors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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