A randomized evaluation of early revascularization to treat shock complicating acute myocardial infarction. The (Swiss) Multicenter Trial of Angioplasty for Shock-(S)MASH

Details

Serval ID
serval:BIB_76A637773781
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
A randomized evaluation of early revascularization to treat shock complicating acute myocardial infarction. The (Swiss) Multicenter Trial of Angioplasty for Shock-(S)MASH
Journal
European Heart Journal
Author(s)
Urban  P., Stauffer  J. C., Bleed  D., Khatchatrian  N., Amann  W., Bertel  O., van den Brand  M., Danchin  N., Kaufmann  U., Meier  B., Machecourt  J., Pfisterer  M.
ISSN
0195-668X (Print)
Publication state
Published
Issued date
07/1999
Volume
20
Number
14
Pages
1030-8
Notes
Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't --- Old month value: Jul
Abstract
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.
Keywords
Aged *Angioplasty, Transluminal, Percutaneous Coronary Coronary Angiography Emergencies Female Hemodynamic Processes Humans Male Middle Aged Myocardial Infarction/complications Patient Selection Shock, Cardiogenic/etiology/mortality/*therapy Survival Analysis Time Factors Treatment Outcome
Pubmed
Web of science
Open Access
Yes
Create date
28/01/2008 10:29
Last modification date
20/08/2019 14:33
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