title: A randomized evaluation of early revascularization to treat shock complicating acute myocardial infarction. The (Swiss) Multicenter Trial of Angioplasty for Shock-(S)MASH.
abstract: OBJECTIVE
  To test whether emergency revascularization improves survival in patients with acute myocardial infarction and shock.
  
  
  RESULTS
  Patients with acute myocardial infarction and early shock were randomized either to undergo emergency angiography, followed immediately by revascularization when indicated, or to receive initial medical management. In five of the nine participating centres, patients with shock but not randomized were entered in a registry. Only 55 patients could be randomized. Of the 32 patients in the invasive group, 30 (94%) underwent early angiography, 27 (84%) PTCA, and one (4%) CABG. Twenty-two (69%) died within 30 days in the invasive group vs 18/23 (78%) in the medically managed group (ns, RR=0.88, 95% confidence interval 0.6-1.2). Among the registry patients, 24/51 were excluded from randomization solely because of patient or physician preference for the invasive approach: 23 (96%) of them underwent emergency angiography, 21 (88%) PTCA, and 12 (50%) died within 30 days. Among the remaining registry patients (n=27) only nine (33%) underwent early angiography, nine (33%) PTCA and 20 (74%) died.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Cardiology Division, CHUV, Lausanne, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Urban
authors.forename: J C
authors.initials: JC
authors.lastname: Stauffer
authors.forename: D
authors.initials: D
authors.lastname: Bleed
authors.forename: N
authors.initials: N
authors.lastname: Khatchatrian
authors.forename: W
authors.initials: W
authors.lastname: Amann
authors.forename: O
authors.initials: O
authors.lastname: Bertel
authors.forename: M
authors.initials: M
authors.lastname: van den Brand
authors.forename: N
authors.initials: N
authors.lastname: Danchin
authors.forename: U
authors.initials: U
authors.lastname: Kaufmann
authors.forename: B
authors.initials: B
authors.lastname: Meier
authors.forename: J
authors.initials: J
authors.lastname: Machecourt
authors.forename: M
authors.initials: M
authors.lastname: Pfisterer
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D004630:Emergencies; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D018579:Patient Selection; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome