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Does current treatment of cardiogenic shock complicating the acute coronary syndromes comply with guidelines?
Am Heart J 2005; 149(1):98-103AH

Abstract

BACKGROUND

The purpose of our study was to evaluate the implementation of guidelines for the treatment of cardiogenic shock (CS) complicating the acute coronary syndromes (ACS).

METHODS AND RESULTS

Of the 10 136 patients in the Euro-Heart-Survey-ACS with complete data, CS occurred in 549 (5.4%), of whom 28.6% had CS upon presentation. We examined the use of coronary angiography (CA), percutaneous (PCI) and surgical (CABG) revascularization, and intra-aortic balloon counterpulsation (IABP) among ACS patients with and without CS. During the hospital course, there were no significant differences between patients with and without CS in referral to CA (52.4% vs 53.3%, respectively) or CABG (4.4% vs 4.5%), but CS patients were more likely to undergo IABP (17.7% vs 0.8%, P < .001) and PCI (40.8% vs 31.8%, P < .001), especially younger (<75 years) patients (52.2% vs 31.8%, P < .001). A similar trend was observed when comparing ST-elevation-ACS patients with (368 [8.5%]) and without CS (3945): CA (58.1% vs 56.2%), CABG (3.6% vs 3.3%), IABP (20.0% vs 0.9%, P < .01), and PCI (47.3% vs 40.6%, P < .01; 54.4% vs. 44.6% for patients <75 years, P < .003). Of the 94 ST-elevation-ACS patients presenting with CS, only 39 (41.4%) received any reperfusion treatment, more often fibrinolysis (64.1%). The in-hospital mortality was 52.1% for all CS pts vs 2.0% for all others (P < .001).

CONCLUSIONS

Our contemporary survey demonstrates prohibitively-high mortality rates among ACS patients complicated by CS and poor implementation of recent guidelines advocating an aggressive invasive approach, including low rates of revascularization and IABP. Improved adherence to the guidelines pertaining to ACS patients developing CS may hopefully improve outcomes.

Authors+Show Affiliations

Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15660040

Citation

Iakobishvili, Zaza, et al. "Does Current Treatment of Cardiogenic Shock Complicating the Acute Coronary Syndromes Comply With Guidelines?" American Heart Journal, vol. 149, no. 1, 2005, pp. 98-103.
Iakobishvili Z, Behar S, Boyko V, et al. Does current treatment of cardiogenic shock complicating the acute coronary syndromes comply with guidelines? Am Heart J. 2005;149(1):98-103.
Iakobishvili, Z., Behar, S., Boyko, V., Battler, A., & Hasdai, D. (2005). Does current treatment of cardiogenic shock complicating the acute coronary syndromes comply with guidelines? American Heart Journal, 149(1), pp. 98-103.
Iakobishvili Z, et al. Does Current Treatment of Cardiogenic Shock Complicating the Acute Coronary Syndromes Comply With Guidelines. Am Heart J. 2005;149(1):98-103. PubMed PMID: 15660040.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does current treatment of cardiogenic shock complicating the acute coronary syndromes comply with guidelines? AU - Iakobishvili,Zaza, AU - Behar,Solomon, AU - Boyko,Valentina, AU - Battler,Alexander, AU - Hasdai,David, PY - 2005/1/22/pubmed PY - 2005/5/17/medline PY - 2005/1/22/entrez SP - 98 EP - 103 JF - American heart journal JO - Am. Heart J. VL - 149 IS - 1 N2 - BACKGROUND: The purpose of our study was to evaluate the implementation of guidelines for the treatment of cardiogenic shock (CS) complicating the acute coronary syndromes (ACS). METHODS AND RESULTS: Of the 10 136 patients in the Euro-Heart-Survey-ACS with complete data, CS occurred in 549 (5.4%), of whom 28.6% had CS upon presentation. We examined the use of coronary angiography (CA), percutaneous (PCI) and surgical (CABG) revascularization, and intra-aortic balloon counterpulsation (IABP) among ACS patients with and without CS. During the hospital course, there were no significant differences between patients with and without CS in referral to CA (52.4% vs 53.3%, respectively) or CABG (4.4% vs 4.5%), but CS patients were more likely to undergo IABP (17.7% vs 0.8%, P < .001) and PCI (40.8% vs 31.8%, P < .001), especially younger (<75 years) patients (52.2% vs 31.8%, P < .001). A similar trend was observed when comparing ST-elevation-ACS patients with (368 [8.5%]) and without CS (3945): CA (58.1% vs 56.2%), CABG (3.6% vs 3.3%), IABP (20.0% vs 0.9%, P < .01), and PCI (47.3% vs 40.6%, P < .01; 54.4% vs. 44.6% for patients <75 years, P < .003). Of the 94 ST-elevation-ACS patients presenting with CS, only 39 (41.4%) received any reperfusion treatment, more often fibrinolysis (64.1%). The in-hospital mortality was 52.1% for all CS pts vs 2.0% for all others (P < .001). CONCLUSIONS: Our contemporary survey demonstrates prohibitively-high mortality rates among ACS patients complicated by CS and poor implementation of recent guidelines advocating an aggressive invasive approach, including low rates of revascularization and IABP. Improved adherence to the guidelines pertaining to ACS patients developing CS may hopefully improve outcomes. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/15660040/Does_current_treatment_of_cardiogenic_shock_complicating_the_acute_coronary_syndromes_comply_with_guidelines L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002870304003965 DB - PRIME DP - Unbound Medicine ER -