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Titolo:
Early revascularization in acute myocardial infarction complicated by cardiogenic shock
Autore:
Hochman, JS; Sleeper, LA; Webb, JG; Sanborn, TA; White, HD; Talley, JD; Buller, CE; Jacobs, AK; Slater, JN; Col, J; McKinlay, SM; LeJemtel, TH;
Indirizzi:
Columbia Univ, St Lukes Roosevelt Hosp Ctr, New York, NY 10025 USA Columbia Univ New York NY USA 10025 velt Hosp Ctr, New York, NY 10025 USA Columbia Univ, New York, NY USA Columbia Univ New York NY USAColumbia Univ, New York, NY USA New England Res Inst, Watertown, MA 02172 USA New England Res Inst Watertown MA USA 02172 Inst, Watertown, MA 02172 USA St Pauls Hosp, Vancouver, BC V6Z 1Y6, Canada St Pauls Hosp Vancouver BC Canada V6Z 1Y6 , Vancouver, BC V6Z 1Y6, Canada New York Hosp, Cornell Med Ctr, New York, NY USA New York Hosp New York NY USA rk Hosp, Cornell Med Ctr, New York, NY USA Green Lane Hosp, Auckland 3, New Zealand Green Lane Hosp Auckland New Zealand 3 ane Hosp, Auckland 3, New Zealand Univ Arkansas, Little Rock, AR 72204 USA Univ Arkansas Little Rock AR USA72204 rkansas, Little Rock, AR 72204 USA Univ British Columbia, Vancouver Gen Hosp, Vancouver, BC V5Z 1M9, Canada Univ British Columbia Vancouver BC Canada V5Z 1M9 ver, BC V5Z 1M9, Canada Boston Med Ctr, Boston, MA USA Boston Med Ctr Boston MA USABoston Med Ctr, Boston, MA USA Clin Univ St Luc, B-1200 Brussels, Belgium Clin Univ St Luc Brussels Belgium B-1200 t Luc, B-1200 Brussels, Belgium Albert Einstein Coll Med, Bronx, NY 10467 USA Albert Einstein Coll Med Bronx NY USA 10467 Coll Med, Bronx, NY 10467 USA
Titolo Testata:
NEW ENGLAND JOURNAL OF MEDICINE
fascicolo: 9, volume: 341, anno: 1999,
pagine: 625 - 634
SICI:
0028-4793(19990826)341:9<625:ERIAMI>2.0.ZU;2-E
Fonte:
ISI
Lingua:
ENG
Soggetto:
TRANSLUMINAL CORONARY ANGIOPLASTY; TISSUE-PLASMINOGEN-ACTIVATOR; GUSTO-I TRIAL; BALLOON COUNTERPULSATION; REPERFUSION THERAPY; NATIONAL REGISTRY; IMPROVES SURVIVAL; MORTALITY; STREPTOKINASE; THROMBOLYSIS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
38
Recensione:
Indirizzi per estratti:
Indirizzo: Hochman, JS Columbia Univ, St Lukes Roosevelt Hosp Ctr, 1111 Amsterdam Ave, New York, NY 10025 USA Columbia Univ 1111 Amsterdam Ave New York NY USA 10025 025 USA
Citazione:
J.S. Hochman et al., "Early revascularization in acute myocardial infarction complicated by cardiogenic shock", N ENG J MED, 341(9), 1999, pp. 625-634

Abstract

Background The leading cause of death in patients hospitalized for acute myocardial infarction is cardiogenic shock. We conducted a randomized trial to evaluate early revascularization in patients with cardiogenic shock. Methods Patients with shock due to left ventricular failure complicating myocardial infarction were randomly assigned to emergency revascularization (152 patients) or initial medical stabilization (150 patients). Revascularization was accomplished by either coronary-artery bypass grafting or angioplasty. Intraaortic balloon counterpulsation was performed in 86 percent of the patients in both groups. The primary end point was mortality from all causes at 30 days. Six-month survival was a secondary end point. Results The mean (+/-SD) age of the patients was 66+/-10 years, 32 percentwere women, and 55 percent had been transferred from other hospitals. The median time to the onset of shock was 5.6 hours after infarction, and most infarcts were anterior in location. Ninety-seven percent of the patients assigned to revascularization underwent early coronary angiography, and 87 percent underwent revascularization; only 2.7 percent of the patients assigned to medical therapy crossed over to early revascularization without clinical indication. Overall mortality at 30 days did not differ significantly between the revascularization and medical-therapy groups (46.7 percent and 56.0 percent, respectively; difference, -9.3 percent; 95 percent confidence interval for the difference, -20.5 to 1.9 percent; P = 0.11). Six-month mortality was lower in the revascularization group than in the medical-therapy group (50.3 percent vs. 63.1 percent, P=0.027). Conclusions In patients with cardiogenic shock, emergency revascularization did not significantly reduce overall mortality at 30 days. However, aftersix months there was a significant survival benefit. Early revascularization should be strongly considered for patients with acute myocardial infarction complicated by cardiogenic shock. (N Engl J Med 1999;341:625-34. ) (C) 1999, Massachusetts Medical Society.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 27/11/20 alle ore 15:31:59