title: Thrombolysis plus aortic counterpulsation: improved survival in patients who present to community hospitals with cardiogenic shock.
abstract: OBJECTIVE
  We sought to explore the potential benefit of combining intraaortic balloon counterpulsation (IABP) with thrombolysis for acute myocardial infarction (MI) complicated by cardiogenic shock.
  
  
  BACKGROUND
  In community hospitals, this condition is usually managed with thrombolysis alone.
  
  
  METHODS
  We reviewed the charts of 335 patients from two community hospitals who presented with acute MI and had cardiogenic shock between 1985 and 1995.
  
  
  RESULTS
  Of 46 patients who underwent thrombolysis within 12 h of acute infarction with confirmed cardiogenic shock, 27 underwent IABP and 19 did not. Age, systolic blood pressure with shock, pulmonary artery catheter use, pulmonary capillary wedge pressure and the incidence of diabetes mellitus and anterior MI did not differ between groups. Patients treated with IABP were somewhat more likely to have prior MI and had a significantly greater cardiac index (2.0 vs. 1.5 liters/min per m2, p = 0.04). Although no deaths occurred within 2 h of presentation, patients not treated with IABP tended to die earlier (6.8 +/- 5 vs. 23.8 +/- 19 h, p = 0.13). Patients treated with IABP had a significantly higher rate of community hospital survival (93% vs. 37%, p = 0.0002), and more of them were transferred for revascularization (85% vs. 37%). Of 30 patients transferred for revascularization, 27 underwent angioplasty or bypass surgery; hospital survival was 74%. Patients treated with IABP also had a significantly higher overall hospital and 1-year survival rate (67% vs. 32%, p = 0.019).
  
  
  CONCLUSIONS
  Survival may be enhanced and transfer for revascularization facilitated when community hospitals use both thrombolysis and IABP to treat patients with acute MI complicated by cardiogenic shock.
authors.affiliation: Division of Cardiology, Botsford General Hospital, Farmington Hills, Michigan, USA.
authors.forename: P J
authors.initials: PJ
authors.lastname: Kovack
authors.forename: M A
authors.initials: MA
authors.lastname: Rasak
authors.forename: E R
authors.initials: ER
authors.lastname: Bates
authors.forename: E M
authors.initials: EM
authors.lastname: Ohman
authors.forename: R J
authors.initials: RJ
authors.lastname: Stomel
mesh_terms: D000368:Aged; D015908:Counterpulsation; D005260:Female; D017052:Hospital Mortality; D006764:Hospitals, Community; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000628:therapy*; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D016019:Survival Analysis; D015912:Thrombolytic Therapy; D013997:Time Factors