AIM: To test whether emergency revascularization improves survival in patients with acute myocardial infarction and shock. METHODS AND 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. CONCLUSION: 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. Copyright 1999 The European Society of Cardiology.
RCT Entities:
AIM: To test whether emergency revascularization improves survival in patients with acute myocardial infarction and shock. METHODS AND 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. CONCLUSION: 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 insufficientpatient inclusion rate, a clinically meaningful benefit of early reperfusion may have been missed. Copyright 1999 The European Society of Cardiology.
Authors: Valentine Léopold; Etienne Gayat; Romain Pirracchio; Jindrich Spinar; Jiri Parenica; Tuukka Tarvasmäki; Johan Lassus; Veli-Pekka Harjola; Sébastien Champion; Faiez Zannad; Serafina Valente; Philip Urban; Horng-Ruey Chua; Rinaldo Bellomo; Batric Popovic; Dagmar M Ouweneel; José P S Henriques; Gregor Simonis; Bruno Lévy; Antoine Kimmoun; Philippe Gaudard; Mir Babar Basir; Andrej Markota; Christoph Adler; Hannes Reuter; Alexandre Mebazaa; Tahar Chouihed Journal: Intensive Care Med Date: 2018-06-01 Impact factor: 17.440
Authors: Robert J Goldberg; Frederick A Spencer; Joel M Gore; Darleen Lessard; Jorge Yarzebski Journal: Circulation Date: 2009-02-23 Impact factor: 29.690