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Rapid complete reversal of systemic hypoperfusion after intra-aortic balloon pump counterpulsation and survival in cardiogenic shock complicating an acute myocardial infarction

Background In patients with cardiogenic shock (CS) complicating an acute myocardial infarction, a strategy of early revascularization (ERV) versus initial medical stabilization (IMS) improves survival. Intra-aortic balloon counterpulsation (IABC) provides hemodynamic support and facilitates coronary... Full description

Journal Title: The American heart journal 2011, Vol.162 (2), p.268-275
Main Author: Ramanathan, Krishnan, MB, ChB
Other Authors: Farkouh, Michael E., MD, MSc , Cosmi, John E., MD , French, John K., MB, ChB, PhD , Harkness, Shannon M., MS , Džavík, Vladimír, MD , Sleeper, Lynn A., ScD , Hochman, Judith S., MD
Format: Electronic Article Electronic Article
Language: English
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Quelle: Alma/SFX Local Collection
Publisher: New York, NY: Mosby, Inc
ID: ISSN: 0002-8703
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title: Rapid complete reversal of systemic hypoperfusion after intra-aortic balloon pump counterpulsation and survival in cardiogenic shock complicating an acute myocardial infarction
format: Article
creator:
  • Ramanathan, Krishnan, MB, ChB
  • Farkouh, Michael E., MD, MSc
  • Cosmi, John E., MD
  • French, John K., MB, ChB, PhD
  • Harkness, Shannon M., MS
  • Džavík, Vladimír, MD
  • Sleeper, Lynn A., ScD
  • Hochman, Judith S., MD
subjects:
  • Abridged Index Medicus
  • Aged
  • Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
  • Biological and medical sciences
  • Cardiogenic shock
  • Cardiology. Vascular system
  • Cardiovascular
  • Cardiovascular disease
  • Coronary heart disease
  • Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care
  • Female
  • Follow-Up Studies
  • Heart
  • Heart attacks
  • Hemodynamics - physiology
  • Hospitals
  • Humans
  • Intensive care medicine
  • Intra-Aortic Balloon Pumping - methods
  • Intubation
  • Logistics
  • Male
  • Medical sciences
  • Middle Aged
  • Mortality
  • Myocardial Infarction - complications
  • Myocardial Infarction - mortality
  • Myocarditis. Cardiomyopathies
  • Prognosis
  • Prospective Studies
  • Recovery of Function - physiology
  • Shock, Cardiogenic - etiology
  • Shock, Cardiogenic - physiopathology
  • Shock, Cardiogenic - therapy
  • Statistical methods
  • Survival Rate - trends
  • Time Factors
ispartof: The American heart journal, 2011, Vol.162 (2), p.268-275
description: Background In patients with cardiogenic shock (CS) complicating an acute myocardial infarction, a strategy of early revascularization (ERV) versus initial medical stabilization (IMS) improves survival. Intra-aortic balloon counterpulsation (IABC) provides hemodynamic support and facilitates coronary angiography and revascularization in CS patients. Methods and Results We evaluated 499 patients with record of systemic hypoperfusion status as an early response to IABC from the SHOCK trial (n = 185) and registry (n = 314) to determine the association between rapid complete reversal of systemic hypoperfusion (CRH) after 30 minutes of IABC and in-hospital, 30-day and 1-year mortality. Rapid complete reversal of systemic hypoperfusion was highly associated with lower in-hospital mortality (29% versus 65%, P < .001) in all patients. In the SHOCK trial, among patients assigned to ERV versus IMS, 30-day mortality was 26% versus 29%, respectively, with CRH and 61% versus 81%, respectively, without CRH after commencing IABC. The corresponding 1-year mortality rates were 35% versus 52% for ERV and 69% versus 87% for IMS (interaction P ≥ .25 at both time points). After adjusting for important correlates of outcome (left ventricular ejection fraction, age, and randomization to ERV), a significant association remained between CRH and registry and trial in-hospital mortality (odds ratio 0.23, 95% CI 0.14-0.39, P < .001) and trial 1-year mortality (odds ratio .28, 95% CI 0.12-0.67, P < .001). Conclusions In CS patients, CRH after commencing IABC was independently associated with improved in-hospital, 30-day and 1-year survival regardless of early revascularization. In CS patients, CRH with IABC is an important early prognostic feature.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0002-8703
fulltext: fulltext
issn:
  • 0002-8703
  • 1097-6744
url: Link


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titleRapid complete reversal of systemic hypoperfusion after intra-aortic balloon pump counterpulsation and survival in cardiogenic shock complicating an acute myocardial infarction
sourceAlma/SFX Local Collection
creatorRamanathan, Krishnan, MB, ChB ; Farkouh, Michael E., MD, MSc ; Cosmi, John E., MD ; French, John K., MB, ChB, PhD ; Harkness, Shannon M., MS ; Džavík, Vladimír, MD ; Sleeper, Lynn A., ScD ; Hochman, Judith S., MD
creatorcontribRamanathan, Krishnan, MB, ChB ; Farkouh, Michael E., MD, MSc ; Cosmi, John E., MD ; French, John K., MB, ChB, PhD ; Harkness, Shannon M., MS ; Džavík, Vladimír, MD ; Sleeper, Lynn A., ScD ; Hochman, Judith S., MD
descriptionBackground In patients with cardiogenic shock (CS) complicating an acute myocardial infarction, a strategy of early revascularization (ERV) versus initial medical stabilization (IMS) improves survival. Intra-aortic balloon counterpulsation (IABC) provides hemodynamic support and facilitates coronary angiography and revascularization in CS patients. Methods and Results We evaluated 499 patients with record of systemic hypoperfusion status as an early response to IABC from the SHOCK trial (n = 185) and registry (n = 314) to determine the association between rapid complete reversal of systemic hypoperfusion (CRH) after 30 minutes of IABC and in-hospital, 30-day and 1-year mortality. Rapid complete reversal of systemic hypoperfusion was highly associated with lower in-hospital mortality (29% versus 65%, P < .001) in all patients. In the SHOCK trial, among patients assigned to ERV versus IMS, 30-day mortality was 26% versus 29%, respectively, with CRH and 61% versus 81%, respectively, without CRH after commencing IABC. The corresponding 1-year mortality rates were 35% versus 52% for ERV and 69% versus 87% for IMS (interaction P ≥ .25 at both time points). After adjusting for important correlates of outcome (left ventricular ejection fraction, age, and randomization to ERV), a significant association remained between CRH and registry and trial in-hospital mortality (odds ratio 0.23, 95% CI 0.14-0.39, P < .001) and trial 1-year mortality (odds ratio .28, 95% CI 0.12-0.67, P < .001). Conclusions In CS patients, CRH after commencing IABC was independently associated with improved in-hospital, 30-day and 1-year survival regardless of early revascularization. In CS patients, CRH with IABC is an important early prognostic feature.
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languageeng
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subjectAbridged Index Medicus ; Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Cardiogenic shock ; Cardiology. Vascular system ; Cardiovascular ; Cardiovascular disease ; Coronary heart disease ; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care ; Female ; Follow-Up Studies ; Heart ; Heart attacks ; Hemodynamics - physiology ; Hospitals ; Humans ; Intensive care medicine ; Intra-Aortic Balloon Pumping - methods ; Intubation ; Logistics ; Male ; Medical sciences ; Middle Aged ; Mortality ; Myocardial Infarction - complications ; Myocardial Infarction - mortality ; Myocarditis. Cardiomyopathies ; Prognosis ; Prospective Studies ; Recovery of Function - physiology ; Shock, Cardiogenic - etiology ; Shock, Cardiogenic - physiopathology ; Shock, Cardiogenic - therapy ; Statistical methods ; Survival Rate - trends ; Time Factors
ispartofThe American heart journal, 2011, Vol.162 (2), p.268-275
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1Farkouh, Michael E., MD, MSc
2Cosmi, John E., MD
3French, John K., MB, ChB, PhD
4Harkness, Shannon M., MS
5Džavík, Vladimír, MD
6Sleeper, Lynn A., ScD
7Hochman, Judith S., MD
title
0Rapid complete reversal of systemic hypoperfusion after intra-aortic balloon pump counterpulsation and survival in cardiogenic shock complicating an acute myocardial infarction
1The American heart journal
addtitleAm Heart J
descriptionBackground In patients with cardiogenic shock (CS) complicating an acute myocardial infarction, a strategy of early revascularization (ERV) versus initial medical stabilization (IMS) improves survival. Intra-aortic balloon counterpulsation (IABC) provides hemodynamic support and facilitates coronary angiography and revascularization in CS patients. Methods and Results We evaluated 499 patients with record of systemic hypoperfusion status as an early response to IABC from the SHOCK trial (n = 185) and registry (n = 314) to determine the association between rapid complete reversal of systemic hypoperfusion (CRH) after 30 minutes of IABC and in-hospital, 30-day and 1-year mortality. Rapid complete reversal of systemic hypoperfusion was highly associated with lower in-hospital mortality (29% versus 65%, P < .001) in all patients. In the SHOCK trial, among patients assigned to ERV versus IMS, 30-day mortality was 26% versus 29%, respectively, with CRH and 61% versus 81%, respectively, without CRH after commencing IABC. The corresponding 1-year mortality rates were 35% versus 52% for ERV and 69% versus 87% for IMS (interaction P ≥ .25 at both time points). After adjusting for important correlates of outcome (left ventricular ejection fraction, age, and randomization to ERV), a significant association remained between CRH and registry and trial in-hospital mortality (odds ratio 0.23, 95% CI 0.14-0.39, P < .001) and trial 1-year mortality (odds ratio .28, 95% CI 0.12-0.67, P < .001). Conclusions In CS patients, CRH after commencing IABC was independently associated with improved in-hospital, 30-day and 1-year survival regardless of early revascularization. In CS patients, CRH with IABC is an important early prognostic feature.
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2Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
3Biological and medical sciences
4Cardiogenic shock
5Cardiology. Vascular system
6Cardiovascular
7Cardiovascular disease
8Coronary heart disease
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10Female
11Follow-Up Studies
12Heart
13Heart attacks
14Hemodynamics - physiology
15Hospitals
16Humans
17Intensive care medicine
18Intra-Aortic Balloon Pumping - methods
19Intubation
20Logistics
21Male
22Medical sciences
23Middle Aged
24Mortality
25Myocardial Infarction - complications
26Myocardial Infarction - mortality
27Myocarditis. Cardiomyopathies
28Prognosis
29Prospective Studies
30Recovery of Function - physiology
31Shock, Cardiogenic - etiology
32Shock, Cardiogenic - physiopathology
33Shock, Cardiogenic - therapy
34Statistical methods
35Survival Rate - trends
36Time Factors
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titleRapid complete reversal of systemic hypoperfusion after intra-aortic balloon pump counterpulsation and survival in cardiogenic shock complicating an acute myocardial infarction
authorRamanathan, Krishnan, MB, ChB ; Farkouh, Michael E., MD, MSc ; Cosmi, John E., MD ; French, John K., MB, ChB, PhD ; Harkness, Shannon M., MS ; Džavík, Vladimír, MD ; Sleeper, Lynn A., ScD ; Hochman, Judith S., MD
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1Aged
2Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
3Biological and medical sciences
4Cardiogenic shock
5Cardiology. Vascular system
6Cardiovascular
7Cardiovascular disease
8Coronary heart disease
9Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care
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11Follow-Up Studies
12Heart
13Heart attacks
14Hemodynamics - physiology
15Hospitals
16Humans
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20Logistics
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22Medical sciences
23Middle Aged
24Mortality
25Myocardial Infarction - complications
26Myocardial Infarction - mortality
27Myocarditis. Cardiomyopathies
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29Prospective Studies
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33Shock, Cardiogenic - therapy
34Statistical methods
35Survival Rate - trends
36Time Factors
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0Ramanathan, Krishnan, MB, ChB
1Farkouh, Michael E., MD, MSc
2Cosmi, John E., MD
3French, John K., MB, ChB, PhD
4Harkness, Shannon M., MS
5Džavík, Vladimír, MD
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atitleRapid complete reversal of systemic hypoperfusion after intra-aortic balloon pump counterpulsation and survival in cardiogenic shock complicating an acute myocardial infarction
jtitleThe American heart journal
addtitleAm Heart J
date2011
risdate2011
volume162
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pages268-275
issn0002-8703
eissn1097-6744
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abstractBackground In patients with cardiogenic shock (CS) complicating an acute myocardial infarction, a strategy of early revascularization (ERV) versus initial medical stabilization (IMS) improves survival. Intra-aortic balloon counterpulsation (IABC) provides hemodynamic support and facilitates coronary angiography and revascularization in CS patients. Methods and Results We evaluated 499 patients with record of systemic hypoperfusion status as an early response to IABC from the SHOCK trial (n = 185) and registry (n = 314) to determine the association between rapid complete reversal of systemic hypoperfusion (CRH) after 30 minutes of IABC and in-hospital, 30-day and 1-year mortality. Rapid complete reversal of systemic hypoperfusion was highly associated with lower in-hospital mortality (29% versus 65%, P < .001) in all patients. In the SHOCK trial, among patients assigned to ERV versus IMS, 30-day mortality was 26% versus 29%, respectively, with CRH and 61% versus 81%, respectively, without CRH after commencing IABC. The corresponding 1-year mortality rates were 35% versus 52% for ERV and 69% versus 87% for IMS (interaction P ≥ .25 at both time points). After adjusting for important correlates of outcome (left ventricular ejection fraction, age, and randomization to ERV), a significant association remained between CRH and registry and trial in-hospital mortality (odds ratio 0.23, 95% CI 0.14-0.39, P < .001) and trial 1-year mortality (odds ratio .28, 95% CI 0.12-0.67, P < .001). Conclusions In CS patients, CRH after commencing IABC was independently associated with improved in-hospital, 30-day and 1-year survival regardless of early revascularization. In CS patients, CRH with IABC is an important early prognostic feature.
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pmid21835287
doi10.1016/j.ahj.2011.04.025
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