Document Detail


Thrombolysis and counterpulsation to improve survival in myocardial infarction complicated by hypotension and suspected cardiogenic shock or heart failure: results of the TACTICS Trial.
MedLine Citation:
PMID:  15976965     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Sustained hypotension, cardiogenic shock, and heart failure all imply a poor prognosis in acute myocardial infarction (MI). We assessed the benefit of adding 48 hours of intra-aortic balloon counterpulsation (IABP) to standard treatment for MI, in an international trial among hospitals without primary angioplasty capabilities. METHODS: We randomized 57 patients with MI complicated by sustained hypotension, possible cardiogenic shock, or possible heart failure to receive either fibrinolytic therapy and IABP or fibrinolysis alone. The primary end point was all-cause mortality at 6 months. RESULTS: In all, IABP was inserted in 27 of 30 assigned patients a median 30 minutes after fibrinolysis began and continued for a median 34 hours. Of the 27 patients assigned to fibrinolysis alone, 9 deteriorated such that IABP was required. The IABP group was at slightly higher risk at baseline, but the incidence of the primary end point did not differ significantly between groups (34% for combined treatment versus 43% for fibrinolysis alone; adjusted P = 0.23). Patients with Killip class III or IV showed a trend toward greater benefit from IABP (6-month mortality 39% for combined therapy versus 80% for fibrinolysis alone; P = 0.05). CONCLUSIONS: While early IABP use was not associated with a definitive survival benefit when added to fibrinolysis for patients with MI and hemodynamic compromise in this small trial, its use suggested a possible benefit for patients with the most severe heart failure or hypotension. ABBREVIATED ABSTRACT: We assessed the benefit of adding 48 hours of intra-aortic balloon counterpulsation to fibrinolytic therapy among 57 patients with acute myocardial infarction complicated by sustained hypotension, possible cardiogenic shock, or possible heart failure. The primary end point, mortality at 6 months, did not differ between groups (34% for combined treatment versus 43% for fibrinolysis alone [n = 27]; adjusted P = 0.23), although patients with Killip class III or IV did show a trend toward greater benefit from IABP (39% for combined therapy versus 80% for fibrinolysis; P = 0.05).
Authors:
E Magnus Ohman; John Nanas; Robert J Stomel; Massoud A Leesar; Dennis W T Nielsen; Daniel O'Dea; Felix J Rogers; Daniel Harber; Michael P Hudson; Elizabeth Fraulo; Linda K Shaw; Kerry L Lee;
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of thrombosis and thrombolysis     Volume:  19     ISSN:  0929-5305     ISO Abbreviation:  J. Thromb. Thrombolysis     Publication Date:  2005 Feb 
Date Detail:
Created Date:  2005-06-24     Completed Date:  2005-09-21     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9502018     Medline TA:  J Thromb Thrombolysis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  33-9     Citation Subset:  IM    
Affiliation:
The University of North Carolina at Chapel Hill, 130 Mason Farm Road, Chapel Hill, NC 27599, USA. mohman@med.unc.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Cause of Death
Female
Heart Failure / complications*
Humans
Hypotension / complications*
Intra-Aortic Balloon Pumping*
Male
Middle Aged
Myocardial Infarction / complications*,  drug therapy*,  mortality,  surgery
Recurrence
Reproducibility of Results
Shock, Cardiogenic / complications*
Survival Analysis
Thrombolytic Therapy*

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


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