Document Detail


Thrombolysis plus aortic counterpulsation: improved survival in patients who present to community hospitals with cardiogenic shock.
MedLine Citation:
PMID:  9180104     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We sought to explore the potential benefit of combining intraaortic balloon counterpulsation (IABP) with thrombolysis for acute myocardial infarction (MI) complicated by cardiogenic shock. BACKGROUND: In community hospitals, this condition is usually managed with thrombolysis alone. METHODS: We reviewed the charts of 335 patients from two community hospitals who presented with acute MI and had cardiogenic shock between 1985 and 1995. RESULTS: Of 46 patients who underwent thrombolysis within 12 h of acute infarction with confirmed cardiogenic shock, 27 underwent IABP and 19 did not. Age, systolic blood pressure with shock, pulmonary artery catheter use, pulmonary capillary wedge pressure and the incidence of diabetes mellitus and anterior MI did not differ between groups. Patients treated with IABP were somewhat more likely to have prior MI and had a significantly greater cardiac index (2.0 vs. 1.5 liters/min per m2, p = 0.04). Although no deaths occurred within 2 h of presentation, patients not treated with IABP tended to die earlier (6.8 +/- 5 vs. 23.8 +/- 19 h, p = 0.13). Patients treated with IABP had a significantly higher rate of community hospital survival (93% vs. 37%, p = 0.0002), and more of them were transferred for revascularization (85% vs. 37%). Of 30 patients transferred for revascularization, 27 underwent angioplasty or bypass surgery; hospital survival was 74%. Patients treated with IABP also had a significantly higher overall hospital and 1-year survival rate (67% vs. 32%, p = 0.019). CONCLUSIONS: Survival may be enhanced and transfer for revascularization facilitated when community hospitals use both thrombolysis and IABP to treat patients with acute MI complicated by cardiogenic shock.
Authors:
P J Kovack; M A Rasak; E R Bates; E M Ohman; R J Stomel
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  29     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1997 Jun 
Date Detail:
Created Date:  1997-06-19     Completed Date:  1997-06-19     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1454-8     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, Botsford General Hospital, Farmington Hills, Michigan, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Counterpulsation
Female
Hospital Mortality
Hospitals, Community
Humans
Intra-Aortic Balloon Pumping*
Male
Middle Aged
Myocardial Infarction / complications,  therapy*
Retrospective Studies
Shock, Cardiogenic / etiology,  mortality*,  therapy*
Survival Analysis
Thrombolytic Therapy*
Time Factors

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


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