title: Impact of invasive strategy for the management of patients with cardiogenic shock after acute myocardial infarction.
abstract: OBJECTIVE
  This study evaluates the influence of early revascularization (with percutaneous transluminal coronary angioplasty (PTCA) and coronary surgery) on short- and long-term survival in patients with cardiogenic shock complicating acute myocardial infarction (AMI).
  
  
  RESULTS
  In-hospital and 6-month survival were retrospectively determined on day 193 (65-270, median +/- 25th and 75th percentiles) in 87 patients who either underwent early invasive reperfusion (group A, n=60) or those who were treated conservatively (group B, n=27). In-hospital mortality was 37% in group A and 56% in group B (P=0.192). Six-month mortality was statistically lower in group A than in group B (30 patients (50%) compared with 25 patients (93%), P=0.005). Being a woman and older age were found to be factors increasing mortality. Lower mortality in the long term was strongly associated with revascularization (odds ratio=0.08, 95% confidence interval=1.54-109). PTCA was found to be an independent predictor of long-term survival (odds ratio= 0.22, 95% confidence interval=0.049-1.00, P=0.050), by multiple logistic regression.
  
  
  CONCLUSIONS
  In conclusion, this study suggests that early revascularization improves long-term survival of patients with cardiogenic shock complicating AMI, even after adjustment for baseline differences between patients who underwent early revascularization and those who did not.
authors.affiliation: Division of Cardiology, University of Mersin, Turkey. obendoven@mersin.edu.tr
authors.forename: Oben
authors.initials: O
authors.lastname: Doven
authors.forename: Mehmet Necdet
authors.initials: MN
authors.lastname: Akkus
authors.forename: Ahmet
authors.initials: A
authors.lastname: Camsari
authors.forename: Hasan
authors.initials: H
authors.lastname: Pekdemir
authors.forename: Dilek
authors.initials: D
authors.lastname: Cicek
authors.forename: Arzu
authors.initials: A
authors.lastname: Kanik
authors.forename: Nehir
authors.initials: N
authors.lastname: Sucu
authors.forename: Barlas
authors.initials: B
authors.lastname: Aytacoğlu
authors.forename: Mahmut Tuna
authors.initials: MT
authors.lastname: Katircibasi
authors.forename: Veli Gokhan
authors.initials: VG
authors.lastname: Cin
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017024:Chemotherapy, Adjuvant; D001026:Coronary Artery Bypass; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000628:therapy*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D015912:Thrombolytic Therapy / Q000379:methods; D000077466:Tirofiban; D014443:Tyrosine / Q000031:analogs & derivatives* / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014443:Tyrosine; D000077466:Tirofiban