Percutaneous Coronary Intervention Vs Coronary Artery Bypass Surgery for Unprotected Left Main Coronary Disease: G-LM Registry
Amin DaoulahAbdulaziz AlasmariAhmad HersiMohammed AlshehriTurki Al GarniReda AbuelattaHaitham AminWael AlmahmeedAlwaleed AljoharBader K. AbumelhaBadr AlzahraniMohamed Ajaz GhaniNooraldaem YousifShahrukh HashmaniSalem M. Al-FaifiHameedullah M. KazimWael RefaatZiad DahdouhFeras KhalielJairam AithalAhmed F. ElmahroukAhmed M. IbrahimAbdelmaksoud ElganadyMohammed A. QutubMohamed Nabil AlamaAbdulwali AbohasanTaher HassanMohammed BalghithAbdulrahman M. AlqahtaniAhmed F. AbdelazizIssam AltnjiAdnan Fathey HussienIbrahim A. M. AbdulhabeebOsama AhmadMamdouh HaddaraAbdulrahman AlqahtaniSaif S. AlshahraniWael QenawiMohamed H IzzeldinOsama El‐SayedAhmed A. JamjoomAbdulrahman Al MoghairiHussein Al AmriWaleed Moubark IbrahimMohsen AlarbashTajammul HussainFahad ShamsiEhab SelimMohamed RamadanHani AlserganiTahir MohamedAbdulwahab Al KhalifaNiranjan HiremathAmira Ali Taha IbrahimHassane AbdallahAmr ElprinceAhmed DiabDiaa Eldin A SeoudAhmed Abdullah AlghamdiKhaled E. Al-EbrahimDuna BasudanFaisal Omar M. Al NasserIbrahim Ahmed Abuagila AliAbeer M ShawkyAhmed A. GhonimAbdullah Al KhushailMaun FeteihSeraj AbualnajaBandar AlhaddadiSameer AlhamidWaleed AhmedZainab M. JafarySamir AhniaJala GasemShahad AlaydarousTamer KhatabAtaaelrahman MohamedMohamed MaghrabiFaisal Al SamadiTareef H KannoutNajeeb MahrousYahya AlmalehAdil B Al RiyamiAltayyeb YousefMohammed AhmedRuqayyah Ali AhmedWael TawfikNasser AlmegrebMazen FadenEjazul HaqSalah N. Al-OtaibiAkram EldesokyFrancis A. ClarksonAmir Lotfi
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EuroSCORE
Interquartile range
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The treatment of patients with advanced acute heart failure is still challenging. Intra-aortic balloon pump (IABP) has widely been used in the management of patients with cardiogenic shock. However, according to international guidelines, its routinary use in patients with cardiogenic shock is not recommended. This recommendation is derived from the results of the IABP-SHOCK II trial, which demonstrated that IABP does not reduce all-cause mortality in patients with acute myocardial infarction and cardiogenic shock. The present position paper, released by the Italian Association of Hospital Cardiologists, reviews the available data derived from clinical studies. It also provides practical recommendations for the optimal use of IABP in the treatment of cardiogenic shock and advanced acute heart failure.
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Transcatheter aortic valve implantation (TAVI) has been introduced to treat patients at high risk for conventional surgery; however, cardiogenic shock is considered a contraindication for TAVI. The aim of the present study was to evaluate early and intermediate mortality of patients in cardiogenic shock undergoing TAVI as a rescue procedure. Patients in cardiogenic shock underwent transapical TAVI with Edwards SAPIEN (Edwards Lifesciences, Irvine, CA, USA) prosthetic valves. Preoperative, perioperative and 1-year follow-up data were analysed. Analysis included 358 patients. Preoperative cardiogenic shock was present in 21 (5.9%) patients. EuroSCORE (cardiogenic shock 73.1 ± 18.9% vs. non-cardiogenic shock 36.0 ± 18.7%; P < 0.0001) and Society of Thoracic Surgeons score (cardiogenic shock 50.8 ± 28.1% vs. non-cardiogenic shock 16.7 ± 12.2%; P < 0.0001) were significantly higher in the cardiogenic shock group, and left ventricular ejection fraction (cardiogenic shock 26.0 ± 13.1% vs. no-cardiogenic shock 51.4 ± 13.0%; P < 0.0001) was significantly lower. Thirty-day mortality was significantly higher in the cardiogenic shock group (cardiogenic shock 19% vs. non-cardiogenic shock 5%; P = 0.02) and 1-year survival significantly lower (cardiogenic shock 46% vs. no-cardiogenic shock 83%; P < 0.0001). At Cox regression, EuroSCORE was the sole determinant for follow-up mortality (odds ratio = 1.02; P = 0.04). TAVI in patients who are in cardiogenic shock is feasible. Although the early and late outcomes are encouraging, a structured strategy should be developed and further experience is needed.
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المقدمة: ان الصدمة القلبية هي السبب الأاشيع لحدوث الوفاة لدى المرضى احتشاء العضلة القلبية الحاد (AMI) اذ تحدث بنسبة 7-10% من مجموع المرضى الذين يقبلون في العناية المشددة بسبب احتشاء حاد
عدد كبير من المرضى يطورون صدمة قلبية بعد الوصول الى المشفى ففي الدراسة GUSTO 11% من المرضى وصلوا الى المشفى بحالة صدمة القلبية بينما 89%طوروا صدمة بعد الاستشفاء ,وفي دراسة SHOCK اكثر من نصف المرضى يطورون صدمة خلال اليوم الاول من الاستشفاء
ان الصدمة القلبية تحدث لدى مرضى الاحشاء مع تزحل STEMI ST نحو الاعلى بنسبة 7.5 % في حين انها تحدث نسبة 2.5 % لدى مرضى الاحتشاء دون تزحل ST نحو الاعلى
كما ان الصدمة القلبية التي تحدث لدى مرضى الاحتشاء السكريين أعلى بضعفين من المرضى غير سكريين لكنه في المقابل ان الانذار متساو لدى المجموعتين
وسائل الدراسة : ان دراستنا دراسة مستقبلية تم اجراءها في وحدة العناية المشددة في مشفى الأسد الجامعي في اللاذقية حيث شملت جميع المرضى الذين تم قبولهم في العناية المشددة بقصة احتشاء عضلة قلبية وذلك خلال الفترة الممتدة بين كانون الثاني لعام 2014 و كانون الثاني لعام 2016
النتائج :ان نسبة الصدمة القلبية لدى مرضى الاحتشاء الذين تضمنتهم دراستنا (17\140 =12.1%) , (5\17 = 29.4%) من المرضى وصلوا الى المشفى بحالة صدمة مقابل (12\17 = 70.6. % ) تم تشخيص حدوث الصدمة القلبية لديهم بعد الاستشفاء كما انة تبين ان عدد المرضى الذين طوروا صدمة قلبية باكرة خلال 24 ساعة بما فيهم مرضى الصدمة القلبية لدى القبول 7\17= 41.7% بلغ عدد المرضى السكريون الذين طورا صدمة قلبية (11 = 70.6 %) مقابل
(5 + 29.4% ) مرضى طوروا صدمة قلبية دون ان يكون لديهم داء سكري ان التقييم بالأمواج فوق صوتية اظهر ان الالية المرضية المسؤولة عن الصدمة القلبية موزعة كما يلي: سوء وظيفة البطين الايسر(11 =58 %) , صدمة بطين ايمن معزول (4 =24% ) , قصور الدسام التاجي الحاد (2 = 11%) , تمزق الحاجز بين البطينين (1 = 5%)
الخاتمة : لقد بلغت نسبة الصدمة القلبية لدى مرضى احتشاء العضلة القلبية الحاد ضمن دراستنا 12.1% وهذه النسبة اعلى بقليل من النسب العالمية وهذا يعود الى تأخر المريض في طلب الاستشارة الطبية وعدم توفر القثطرة القلبية على مدار اليوم
Introduction: The cardiogenic chock is the most cause of death following to acute myocardial infarction (IMA) ,it occurs( 10%) in patients who are hospitalized in soins intensive for acute myocardial infarction
Lot of patient with acute myocardial infarction develops cardiogenic shock after arriver to hospital
The cardiogenic chock with STEMI (7.5%) is more than its with NSTEMI (2.5%)
The cardiogenic chock occurs in diabetic patients two field more than non diabetic patient may the prognosis is the same
Study methods: our study is retrospective has been done in soins intensive in University Alassad hospital in Lattaquie
It includes all patients admitted for acute myocardial infarction pendant the period from January 2014 to January 2016
Results :The percentage of cardiogenic shock in our study is( 12%) .(29.4%)of them are arrived to hospital with cardiogenic shock while( 70.6%) developed cardiogenic shock pendant their hospitalization
The responsible pathologies of cardiogenic shock were as following: left ventricular dysfunction (58%) isolated right ventricular shock( 24% ) acute mitral valve insufficiency (11%),septa l interventricular rupture(5%)
Conclusion : The percentage of cardiogenic shock in our study is 12.1%, it is more than the national percentage because the patient demands the medical consultation too late and there is n t coronarography 24/24 in our hospital
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Cardiogenic shock represents a complication in up to 10% of patients with acute myocardial infarction. Cardiogenic shock mortality remains high. In the contemporary treatment inhibitors of NO synthase are studied, apart from classic medications. Mechanical circulatory support is also important in majority of patients with cardiogenic shock: intraaortic balloon contrapulsation, left ventricular assist device systems. Prognosis is improved by percutaneous coronary intervention.
Myocardial infarction complications
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Cardiogenic shock is a severe cardiovascular disease. If treated properly,the survivors of cardiogenic shock would have better prognosis. Recently,great advances have been obtained in the treatment of cardiogenic shock including drug treatment,intra-aortic balloon counterpulsation,reperfusion,left ventricular assist devices and in turn providing the main managements.
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The SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK (SHOCK) Trial showed no benefit of early revascularization in patients aged >/=75 years with acute myocardial infarction and cardiogenic shock. We examined the effect of age on treatment and outcomes of patients with cardiogenic shock in the SHOCK Trial Registry.We compared clinical and treatment factors in patients in the SHOCK Trial Registry with shock due to pump failure aged <75 years (n=588) and >/=75 years (n=277), and 30-day mortality of patients treated with early revascularization <18 hours since onset of shock and those undergoing a later or no revascularization procedure. After excluding early deaths covariate-adjusted relative risk and 95% confidence intervals were calculated to compare the revascularization strategies within the two age groups. Older patients more often had prior myocardial infarction, congestive heart failure, renal insufficiency, other comorbidities, and severe coronary anatomy. In-hospital mortality in the early vs. late or no revascularization groups was 45 vs. 61% for patients aged <75 years (p=0.002) and 48 vs. 81% for those aged >/=75 years (p=0.0003). After exclusion of 65 early deaths and covariate adjustment, the relative risk was 0.76 (0.59, 0.99; p=0.045) in patients aged <75 years and 0.46 (0.28, 0.75; p=0.002) in patients aged >/=75 years.Elderly patients with myocardial infarction complicated by cardiogenic shock are less likely to be treated with invasive therapies than younger patients with shock. Covariate-adjusted modeling reveals that elderly patients selected for early revascularization have a lower mortality rate than those receiving a revascularization procedure later or never.
Myocardial infarction complications
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