Abstract | BACKGROUND: METHODS AND RESULTS: Of the 302 trial patients, 128 with predominant left ventricular failure had emergency revascularization. The selection of revascularization procedures was individualized. Eighty-one patients (63.3%) had PCI, and 47 (36.7%) had CABG. The median time from randomization to intervention was 0.9 hours (interquartile range [IQR], 0.3 to 2.2 hours) for PCI and 2.7 hours (IQR, 1.3 to 5.5 hours) for CABG. Baseline demographics and hemodynamics were similar, except that there were more diabetics (48.9% versus 26.9%; P=0.02), 3-vessel disease (80.4% versus 60.3%; P=0.03), and left main coronary disease (41.3% versus 13.0%; P=0.001) in the CABG group. In the PCI group, 12.3% had 2-vessel and 2.5% had 3-vessel interventions. In the CABG group, 84.8% received > or =2 grafts, 52.2% received > or =3 grafts, and 87.2% were deemed completely revascularized. The survival rates were 55.6% in the PCI group compared with 57.4% in the CABG group at 30 days (P=0.86) and 51.9% compared with 46.8%, respectively, at 1 year (P=0.71). CONCLUSIONS: Among SHOCK trial patients randomized to emergency revascularization, those treated with CABG had a greater prevalence of diabetes and worse coronary disease than those treated with PCI. However, survival rates were similar. Emergency CABG is an important component of an optimal treatment strategy in patients with cardiogenic shock, and should be considered a complementary treatment option in patients with extensive coronary disease.
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Authors | Harvey D White, Susan F Assmann, Timothy A Sanborn, Alice K Jacobs, John G Webb, Lynn A Sleeper, Cheuk-Kit Wong, James T Stewart, Philip E G Aylward, Shing-Chiu Wong, Judith S Hochman |
Journal | Circulation
(Circulation)
Vol. 112
Issue 13
Pg. 1992-2001
(Sep 27 2005)
ISSN: 1524-4539 [Electronic] United States |
PMID | 16186436
(Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)
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Topics |
- Aged
- Aging
- Angioplasty, Balloon, Coronary
- Coronary Artery Bypass
- Coronary Artery Disease
(physiopathology)
- Diabetes Complications
- Emergency Medical Services
- Female
- Humans
- Male
- Middle Aged
- Models, Statistical
- Myocardial Infarction
(complications, etiology, mortality, therapy)
- Severity of Illness Index
- Shock, Cardiogenic
(complications)
- Survival Analysis
- Treatment Outcome
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