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European Journal of Heart Failure 2008 10(7):668-674; doi:10.1016/j.ejheart.2008.04.015
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© 2008 European Society of Cardiology

Percutaneous coronary intervention for acute MI does not prevent in-hospital development of cardiogenic shock compared to fibrinolysis

Matias G. Lindholma,*, Søren Boesgaarda, Jens Jakob Thunea, Henning Kelbaeka, Henning Rud Andersenb, Lars Kobera DANAMI-2 investigators

a Medical Department B, Division of Cardiology, Rigshospitalet, University Hospital of Copenhagen Denmark
b Department of Cardiology, Skejby Hospital, University Hospital of Aarhus Denmark

* Corresponding author. Medical Department B72, Hospital of Roskilde, Kogevej 7-13, DK-4000 Roskilde, Denmark. Tel.: +45 25 38 36 01; fax: +45 35 45 25 13. E-mail address: Matiasgl{at}dadlnet.dk (M.G. Lindholm).


  Abstract

Background: It has been speculated that invasive revascularization prevents development of cardiogenic shock. Data from randomised trials comparing angioplasty with fibrinolysis on the development of cardiogenic shock are lacking.

Aims: To elucidate the effect of angioplasty on in-hospital development of cardiogenic shock compared to fibrinolysis.

To evaluate whether mortality in patients who develop cardiogenic shock after treatment is dependent on revascularization strategy.

Methods and results: DANAMI-2 randomly assigned 1572 STEMI patients to fibrinolysis (782 patients) or angioplasty (790 patients). Data on patients with in-hospital development of cardiogenic shock after randomisation were included. Of the 103 patients (6.6%) patients developing cardiogenic shock 57% were randomised to angioplasty with an unadjusted odds ratio of 1.39 (0.92–2.11, p=0.14). During the three year follow-up 58% of the total mortality was due to cardiogenic shock, and treatment strategy did not influence the risk associated with shock (hazard ratio of 1.05 (0.67–1.64) for angioplasty vs. fibrinolysis).

Conclusions: Angioplasty does not prevent the in-hospital development of cardiogenic shock complicating acute MI compared to fibrinolysis. Cardiogenic shock is still the leading cause of death in patients hospitalised for acute MI. There was no difference in mortality, with regards to treatment strategy in patients developing cardiogenic shock after the initial treatment.

Key Words: Acute heart failure • Cardiogenic shock • Angioplasty • Revascularization • Acute myocardial infarction

Received July 13, 2007; Revised April 8, 2008; Accepted April 28, 2008


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