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Circulation, Vol 78, 1345-1351, Copyright © 1988 by American Heart Association
L Lee, ER Bates, B Pitt, JA Walton, N Laufer and WW O'Neill
Modest survival benefits have been reported in patients with acute
myocardial infarction complicated by cardiogenic shock who were treated
with early surgical revascularization or thrombolytic therapy. To determine
whether coronary angioplasty improves survival, 87 patients with
cardiogenic shock complicating acute myocardial infarction at the
University of Michigan, Ann Arbor, Michigan, from 1975 to 1985 were
retrospectively analyzed. Patients in group 1 (n = 59) were treated with
conventional therapy; patients in group 2 (n = 24) were treated with
conventional therapy and angioplasty. Extent of coronary artery disease,
infarct location, and incidence of multivessel disease were similar between
groups. Hemodynamic variables including cardiac index, mean arterial
pressure, and pulmonary capillary wedge pressure were also similar. The
30-day survival was significantly improved for group 2 patients (50% vs.
17%, p = 0.006). Survival in group 2 patients with successful angioplasty
was 77% (10 of 13 patients) versus 18% (two of 11 patients) in patients
with unsuccessful angioplasty, (p = 0.006). The findings suggest that
angioplasty improves survival in cardiogenic shock compared with
conventional therapy with survival contingent upon successful reperfusion
of the infarct-related artery.
ARTICLES
Percutaneous transluminal coronary angioplasty improves survival in acute myocardial infarction complicated by cardiogenic shock
Department of Internal Medicine, University of Michigan, Ann Arbor.
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