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Second Congress of Cardiology and Angiology of Bosnia & Herzegovina

 

MYOCARDIAL INFARCTION COMPLICATED BY CARDIOGENIC SHOCK
P. Urban .
Hopital de la Tour, Geneve, Switzerland

The incidence of cardiogenic shock (CS) in the course of AMI is ca. 7 to 10%. Prognosis remains poor and the hospital mortality varies between 50 and 80%. It is critical to realise that death occurs at an early stage, i.e. generally during the first 48 hours after onset of CS, and that the therapeutic interventions must therefore be applied early to be effective.. Intravenous thrombolysis can prevent the development of cardiogenic shock when administered before refractory hypotension occurs, but it is ineffective when used for patients with established CS. Mechanical revascularisation, whether surgical or percutaneous, has been associated with an improved prognosis in numerous retrospective studies. Recently, two randomised prospective studies (SMASH and SHOCK) have evaluated the benefit of emergent revascularisation. in patients with CS. Overall, both trials demonstrated that a strategy of immediate revascularisation, together with iv inotropes and aortic counterpulsation support, was associated with a short term absolute mortality reduction of 9%, and an even greater benefit (13.2% mortality reduction) after a follow-up period of 1 year. This latter figure corresponds to 132 lives saved for 1000 patients treated, or a NNT of 7.6. Based on these data, it appears that urgent referral for immediate catheterisation is the best current strategy for a majority of patients with CS following myocardial infarction.

Drugi kongres kardiologa i angiologa Bosne i Hercegovine
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