We failed to demonstrate that emergency PTCA significantly improves survival in patients with acute myocardial infarction and early cardiogenic shock. Because the study was stopped prematurely, due to an insufficient patient inclusion rate, a clinically meaningful benefit of early reperfusion may have been missed.

BACKGROUND Long-term trends of the incidence and outcome of cardiogenic shock (CS) patients are scarce. We analyze for the first time trends in the incidence and outcome of CS during a 20-year period in Switzerland. METHODS AND RESULTS The AMIS (Acute Myocardial Infarction in Switzerland) Plus Registry enrolls patients with acute myocardial infarction from 83 hospitals in Switzerland. We analyzed trends in the incidence, treatment, and in-hospital mortality of patients with CS enrolled between 1997 and 2017. The impact of revascularization strategy on outcome was assessed for the time period 2005 to 2017. Among 52 808 patients enrolled, 963 patients were excluded because of missing data and 51 842 (98%) patients remained for the purpose of the present analysis. Overall, 4090 patients (7.9%) with a mean age of 69.6±12.5 years experienced acute myocardial infarction complicated by CS. Overall, rates of CS declined from 8.

No abstract

Summary: Left ventricular ejection fraction (LVEF) is a measure of ventricular function with clinical and prognostic significance and can be reliably calculated with various M-mode and two-dimensional echocardiographic formulas in selected, good quality echocardiograms. Subjective visual echocardiographic estimate of LVEF is a potentially less time consuming and more widely applicable method. In order to test its reliability, we performed a prospective blind trial in 40 consecutive patients undergoing biplane contrast ventriculography (BCV), to compare the visual estimate of LVEF during a complete echocardiogram of three independent observers with (I) cubed Mmode formula, (2) Teichholz M-mode formula, (3) lengtharea method from the four-chamber view, and (4) Simpson's single plane formula. BCV was the reference method. The best correlation with BCV was obtained by visual estimate [r of the three observers, respectively = 0.75; 0.84; 0.811 and M-mode measurements [r (1) = 0.8; r (2) = 0.81, but the most sophisticated methods provided the poorest estimate [r (3) =0.54; r (4) = 0.491. All correlation coefficients improved when good studies, defined as a definition of the endocardia1 surface of more than 75%, were selected (n = 23), but the differences persisted. One observer systematically estimated higher values than the other two (Friedman's test, p <0.01) and this interobserver variability suggests that each echocardiographer should test himself against BCV in his lab in order to apply the visual estimate method reliably.

It is concluded that several angiographic variables are significantly associated with late angiographic narrowing after stenting in the coronary arteries. We suggest that stent operators avoid excessive oversizing in the selection of stent diameter and the use of multiple stents per lesion to lessen the risk of late restenosis.

This study confirms that dipyridamole is more accurate than exercise in excluding LAD coronary artery disease. However, there are still false-positive results and the severity of the septal or anteroseptal perfusion defect does not add additional information to identify LAD coronary artery disease. Coronary angiography is thus necessary for positive dipyridamole study results to identify coronary artery disease as a major prognostic factor in patients with LBBB.

Objective: To document the trends in reperfusion therapy for ST segment elevation myocardial infarction (STEMI) in Switzerland. Design: National prospective multicentre registry, AMIS Plus (acute myocardial infarction and unstable angina in Switzerland), of patients admitted with acute coronary syndromes. Setting: 54 hospitals of varying size and capability in Switzerland. Patients: 7098 of 11 845 AMIS Plus patients who presented with ST segment elevation or left bundle branch block on the ECG at admission. Main outcome measures: In-hospital mortality and its predictors at admission by multivariate analysis. Results: The proportion of patients treated by primary percutaneous coronary intervention (PCI) progressively increased from 1997 to 2002, while the proportion with thrombolysis or no reperfusion decreased (from 8.0% to 43.1%, from 47.2% to 25.6%, and from 44.8% to 31.4%, respectively). Overall in-hospital mortality decreased over the study period from 12.2% to 6.7% (p , 0.001). Main in-hospital mortality predictors by multivariate analysis were primary PCI (odds ratio (OR) 0.52, 95% confidence interval (CI) 0.33 to 0.81), thrombolysis (OR 0.63, 95% CI 0.47 to 0.83), and Killip class III (OR 3.61, 95% CI 2.49 to 5.24) and class IV (OR 5.97, 95% CI 3.51 to 10.17) at admission. When adjusted for the year, multivariate analysis did not show PCI to be significantly superior to thrombolysis for in-hospital mortality (OR 1.2 for PCI better, 95% CI 0.8 to 1.9, p = 0.42). Conclusion: Primary PCI has become the preferred mode of reperfusion for STEMI since 2002 in Switzerland, whereas use of intravenous thrombolysis has decreased from 1997 to 2002. Furthermore, there was a major reduction of in-hospital mortality over the same period. Since it was found in the mid 1970s that acute myocardial infarction resulted from a ruptured atherosclerotic plaque, causing thrombosis and occlusion of a coronary artery, 1 and that restoration of flow salvages myocardium, major attention has been focused on reperfusion therapy. Several studies have documented the survival benefit provided by a thrombolytic, first by intracoronary administration and later intravenously.2-5 Numerous randomised controlled trials soon followed comparing intravenous thrombolysis with mechanical reperfusion by primary percutaneous coronary intervention (PCI). A meta-analysis of 23 randomised controlled trials comparing these two modes of reperfusion in ST segment elevation myocardial infarction (STEMI) showed a greater benefit associated with primary PCI in terms of short and long term mortality, non-fatal reinfarction, and stroke. 6 On the basis of this information, national and international societies of cardiology have established guidelines concerning the management of STEMI.7 8 To assess how these translate into the ''real world'' of daily clinical practice, several short and long term registry based studies have been conducted. [9][10][11][12][13][14][15]

Conclusions-Clinical, procedural and angiographic variables increase the risk for early closure and restenosis after endoluminal stenting. The prediction models described above need to be validated prospectively. (Br HeartJ7 1995;74:592-597)