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Titolo:
Impact of thrombolysis, intra-aortic balloon pump counterpulsation, and their combination in cardiogenic shock complicating acute myocardial infarction: A report from the SHOCK Trial Registry
Autore:
Sanborn, TA; Sleeper, LA; Bates, ER; Jacobs, AK; Boland, J; French, JK; Dens, J; Dzavik, V; Palmeri, ST; Webb, JG; Goldberger, M; Hochman, JS;
Indirizzi:
Cornell Univ, Weil Med Coll, New York Presbyterian Hosp, New York, NY USA Cornell Univ New York NY USA ew York Presbyterian Hosp, 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 Univ Michigan, Med Ctr, Ann Arbor, MI USA Univ Michigan Ann Arbor MI USAUniv Michigan, Med Ctr, Ann Arbor, MI USA Boston Med Ctr, Boston, MA USA Boston Med Ctr Boston MA USABoston Med Ctr, Boston, MA USA CHR Citadelle, Liege, Belgium CHR Citadelle Liege BelgiumCHR Citadelle, Liege, Belgium Green Lane Hosp, Auckland 3, New Zealand Green Lane Hosp Auckland New Zealand 3 ane Hosp, Auckland 3, New Zealand Univ Hosp Gasthuisberg, B-3000 Louvain, Belgium Univ Hosp Gasthuisberg Louvain Belgium B-3000 g, B-3000 Louvain, Belgium Univ Alberta Hosp, Edmonton, AB T6G 2B7, Canada Univ Alberta Hosp Edmonton AB Canada T6G 2B7 Edmonton, AB T6G 2B7, Canada Univ Med & Dent New Jersey, Robert Wood Johnson Med Sch, New Brunswick, NJUSA Univ Med & Dent New Jersey New Brunswick NJ USA ch, New Brunswick, NJUSA St Pauls Hosp, Vancouver, BC V6Z 1Y6, Canada St Pauls Hosp Vancouver BC Canada V6Z 1Y6 , Vancouver, BC V6Z 1Y6, Canada Montefiore Med Ctr, Bronx, NY 10467 USA Montefiore Med Ctr Bronx NY USA 10467 efiore Med Ctr, Bronx, NY 10467 USA St Lukes Roosevelt Hosp, New York, NY 10025 USA St Lukes Roosevelt Hosp New York NY USA 10025 osp, New York, NY 10025 USA
Titolo Testata:
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
fascicolo: 3, volume: 36, anno: 2000, supplemento:, A
pagine: 1123 - 1129
SICI:
0735-1097(200009)36:3<1123:IOTIBP>2.0.ZU;2-R
Fonte:
ISI
Lingua:
ENG
Soggetto:
TRANSLUMINAL CORONARY ANGIOPLASTY; EARLY REVASCULARIZATION; IMPROVES SURVIVAL; REPERFUSION; BYPASS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
28
Recensione:
Indirizzi per estratti:
Indirizzo: Sanborn, TA Northwestern Univ, Evanston Hosp, Div Cardiol, Burch 300,2650 Ridge Ave, Evanston, IL 60201 USA Northwestern Univ Burch 300,2650 Ridge Ave Evanston IL USA 60201
Citazione:
T.A. Sanborn et al., "Impact of thrombolysis, intra-aortic balloon pump counterpulsation, and their combination in cardiogenic shock complicating acute myocardial infarction: A report from the SHOCK Trial Registry", J AM COL C, 36(3), 2000, pp. 1123-1129

Abstract

OBJECTIVES We sought to investigate the potential benefit of thrombolytic therapy (TT) and intra-aortic balloon pump counterpulsation (IABP) on in-hospital mortality rates of patients enrolled in a prospective, multi-center Registry of acute myocardial infarction (MI) complicated by cardiogenic shock (CS). BACKGROUND Retrospective studies suggest that patients suffering from CS due to MI have lower in-hospital mortality rates when IABP support is added to TT. This hypothesis has not heretofore been examined prospectively in a study devoted to CS. METHODS Of 1,190 patients enrolled at 36 participating centers, 884 patients had CS due to predominant left ventricular (LV) failure. Excluding 26 patients with IABP placed prior to shock onset and 2 patients with incompletedata, 856 patients were evaluated regarding TT and IABP utilization. Treatments, selected by local physicians, fell into four categories: no TT, no IABP (33%; n = 285); IABP only (33%; n = 279); TT only (15%; n = 132); and TT and IABP (19%; n = 160). RESULTS Patients in CS treated with TT had a lower in-hospital mortality than those who did not receive TT (54% vs. 64%, p = 0.005), and those selected for IABP had a lower in-hospital mortality than those who did not receive IABP (50% vs. 72%, p < 0.0001). Furthermore, there was a significant difference in in-hospital mortality among the four treatment groups: TT + IABP (47%), IABP only (52%), TT only (63%), no TT, no IABP (77%) (p < 0.0001). Patients receiving early IABP (less than or equal to 6 h after thrombolytic therapy, n = 72) had in-hospital mortality similar to those with late IABP (53% vs. 41%, n = 64, respectively, p = 0.172). Revascularization rates differed among the four groups: no TT, no IABP (18%); IABP only (70%); TT only(20%); TT and IABP (68%, p < 0.0001); this influenced in-hospital mortality significantly (39% with revascularization vs. 78% without revascularization, p < 0.0001). CONCLUSIONS Treatment of patients in cardiogenic shock due to predominant LV failure with TT, IABP and revascularization by PTCA/CABG was associated with lower in-hospital mortality rates than standard medical therapy in this Registry. For hospitals without revascularization capability, a strategy of early TT and IABP followed by immediate transfer for PTCA or CABG may beappropriate. However, selection bias is evident and further investigation is required. (J Am Coll Cardiol 2000;36:1123-9) (C) 2000 by the American College of Cardiology.

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Documento generato il 26/11/20 alle ore 07:37:37