A randomized evaluation of early revascularization to treat shock complicating acute myocardial infarction. The (Swiss) Multicenter Trial of Angioplasty for Shock—(S)MASH

Urban, Philip; Stauffer, J. C.; Bleed, D.; Khatchatrian, Naira; Amann, W; Bertel, Osmund; Brand, Marcel van den; Danchin, Nicolás; Kaufmann, U; Meier, Bernhard; Machecourt, J; Pfisterer, Matthias; investigators, Mash

doi:10.1053/euhj.1998.1353

Cited by 177 publications

(94 citation statements)

References 17 publications

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“…19 The higher mortality rates in that trial (69 percent among patients assigned to emergency revascularization and 78 percent among patients assigned to medical therapy) than in our trial were consistent with the requirement that patients have no response to initial supportive measures. The 9 percent absolute difference between the groups in 30-day mortality was the same as that in our study.…”

Section: Comparison With Prior Studiessupporting

confidence: 84%

“…16,17 A prematurely terminated randomized trial comparing angioplasty with conventional therapy for shock in 55 patients reported no difference in mortality. 19 Most patients with cardiogenic shock do not undergo emergency revascularization, either because of the lack of facilities at the hospitals where they present or because of doubt as to its efficacy. 18,[20][21][22] If early revascularization reduces mortality, angioplasty or coronary-artery bypass graft surgery should be performed on an urgent basis, even if this requires transfer to a hospital with the necessary facilities and expertise.…”

Section: Discussionmentioning

confidence: 99%

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Early Revascularization in Acute Myocardial Infarction Complicated by Cardiogenic Shock

et al. 1999

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Section: Comparison With Prior Studiessupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Early Revascularization in Acute Myocardial Infarction Complicated by Cardiogenic Shock

et al. 1999

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“…The benefit was similar in the incomplete, randomized Swiss Multicenter Study of Angioplasty for Shock. 56 Numerous registry studies have confirmed the survival advantage of early revascularization, whether percutaneous or surgical, in the young and the elderly. Thrombolytic therapy is less effective but is indicated when PCI is impossible or if a delay has occurred in transport for PCI and when MI and CS onset were within 3 hours.…”

Section: Reperfusionmentioning

confidence: 99%

Cardiogenic Shock

2008

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ardiogenic shock (CS) occurs in Ϸ5% to 8% of patients hospitalized with ST-elevation myocardial infarction (STEMI). Recent research has suggested that the peripheral vasculature and neurohormonal and cytokine systems play a role in the pathogenesis and persistence of CS. Early revascularization for CS improves survival substantially. New mechanical approaches to treatment are available, and clinical trials are feasible even in this high-risk population. Most importantly, hospital survivors have an excellent chance for long-term survival with good quality of life. This review will outline the causes, pathophysiology, and treatment of CS with a focus on CS complicating myocardial infarction (MI.) The case will be made for viewing CS as a serious disorder with a high early death rate, but one that is treatable and that, if approached aggressively, can result in full recovery. The diagnosis is usually made with the help of pulmonary artery (PA) catheterization; however, Doppler echocardiography may also be used to confirm elevation of LV filling pressures. 1 Hypoperfusion may be manifest clinically by cool extremities, decreased urine output, and/or alteration in mental status. Hemodynamic abnormalities form a spectrum that ranges from mild hypoperfusion to profound shock, and the short-term outcome is directly related to the severity of hemodynamic derangement. MI with LV failure remains the most common cause of CS. It is critical to exclude complicating factors that may cause shock in MI patients. Chief among these are the mechanical complications: ventricular septal rupture, contained free wall rupture, and papillary muscle rupture. Mechanical complications must be strongly suspected in patients with CS complicating nonanterior MI, particularly a first MI. Echocardiography is the technique of choice to rule out these entities and should be performed early unless the diagnosis is extensive anterior MI and the patient is undergoing prompt percutaneous coronary intervention (PCI). In addition, the detection of valvular disease before angiography may alter the revascularization approach. Diagnosis and CausesHemorrhage, infection, and/or bowel ischemia may contribute to shock in the setting of MI. As with mechanical complications, a high index of suspicion is required to make these diagnoses in MI patients, and survival may depend on timely recognition and treatment.Any cause of acute, severe LV or RV dysfunction may lead to CS. Acute myopericarditis, tako-tsubo cardiomyopathy, and hypertrophic cardiomyopathy may all present with ST elevation, release of cardiac markers, and shock in the absence of significant coronary artery disease. Stress-induced cardiomyopathy, also known as apical ballooning or takotsubo cardiomyopathy, is a syndrome of acute LV dysfunction after emotional or respiratory distress that leads to CS in 4.2% of cases. 2 Acute valvular regurgitation, typically caused by endocarditis or chordal rupture due to trauma or degenerative disease, may also cause CS. Aortic dissection may lead to CS via acute,...

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“…The higher mortality rate may have been due to the inclusion of sicker patients that remained hypotensive despite inotropic support and volume replacement. This study terminated early because of difficulties in patient recruitment 42 .…”

Section: I) Revascularization In Multivessel Coronary Artery Diseasementioning

confidence: 99%

Pulmonary Hypertension in A Patient with Systemic Sclerosis

S.T¹,

Ezennaka²

2017

IOSR JDMS

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INTRODUCTION:Cardiogenic shock (CS) is defined as a state of critical end organ hypoperfusion due to reduced cardiac output.The most frequent cause is acute myocardial infarction (AMI) with subsequent ventricular dysfunction in about 80% of cases. In spite of the advances made in the treatment of AMI, cardiogenic shock remains a leading cause of death with mortality rates approaching 40-50%. AIM: The purpose of this review is to highlight the current concepts in the management of cardiogenic shock. MATERIALS AND METHODS: A systematic review of published literature using PubMed and Med Line was done using search items like "cardiogenic and shock". Secondary references obtained from this publication were identified by manual search and reviewed as relevant. RESULTS: Cardiogenic shock is characterized by inadequate tissue perfusion in the setting of adequate intravascular volume. The treatment involves general supportive measures which include; adequate oxygenation and ventilation, correction of electrolytes and acid-base abnormalities, pain reliefand restoration of sinus rhythm. Revascularizationand mechanical supports are also necessary. CONCLUSION:The diagnosis and management of cardiogenic shock are difficult and require extensive knowledge and clinical experience. In spite of the significant advances made, the management still remains a challenge.

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A randomized evaluation of early revascularization to treat shock complicating acute myocardial infarction. The (Swiss) Multicenter Trial of Angioplasty for Shock—(S)MASH

Cited by 177 publications

References 17 publications

Early Revascularization in Acute Myocardial Infarction Complicated by Cardiogenic Shock

Early Revascularization in Acute Myocardial Infarction Complicated by Cardiogenic Shock

Cardiogenic Shock

Pulmonary Hypertension in A Patient with Systemic Sclerosis

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