[Elective primary angioplasty in cardiogenic shock: results from a single center].
BACKGROUND
Cardiogenic shock is the leading cause of death among patients hospitalized for acute myocardial infarction. Conventional treatment for acute myocardial infarction does not achieve a better outcome in these patients, but prior studies with emergency revascularization by coronary angioplasty seem to provide encouraging results.


METHODS
A retrospective study of the clinical and angiographic results of elective primary angioplasty in 48 patients with cardiogenic shock complicating acute myocardial infarction of less than 12 hours is described. Intraaortic balloon counterpulsation was used in 79% of the patients. Patients with cardiogenic shock secondary to mechanical complications were excluded.


RESULTS
Angiographic success, defined as a residual stenosis < 50% and final TIMI flow >/= 2, was achieved in 85% of the culprit lesions, and stents were implanted in 76%. Multivessel angioplasty was performed in 25% of the patients, and abciximab was used in 35% of the cases. Mean time from the onset of symptoms to angioplasty was 7.4 +/- 3.1 hours. In-hospital survival was 58%, and was 54% at six months follow-up.


CONCLUSIONS
Emergency coronary revascularization with primary angioplasty and intracoronary stenting is effective in patients with acute myocardial infarction and cardiogenic shock. TIMI flow >/= 2 is achieved in most patients, and mortality is reduced when compared with conservative treatment in historical series.
Hernández Hernández
F
F
Sección de Hemodinámica y Cardiología Intervencionista. Servicio de Cardiología. Hospital Universitario 12 de Octubre. Madrid. fhernandezh@medynet.com
Hernández Simón
P
P
Andreu Dussac
J
J
Albarrán González-Trevilla
A
A
Velázquez Martín
M T
MT
Alonso Gutiérrez
M
M
Tascón Pérez
J C
JC
D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006353:Heart-Assist Devices; D017052:Hospital Mortality; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011859:Radiography; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D015607:Stents
D010975:Platelet Aggregation Inhibitors
Angioplastia primaria electiva en el shock cardiogénico: resultados de un estudio unicéntrico.