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Heart Disease & Chest Pain Treatment At NT Cardiovascular Center Georgia
- 1. Cardiogenic Shock Nick Tehrani, MD
- 2. Definition <90 mmHg <2.2 li/min.m2 >15 mmHg
- 3. SHOCK Registry JACC Sept. 2000, Supp. A Spectrum of Clinical Presentations 5.6% 28% 65% 1.4% Mortality Respiratory Distress Hypotension Hypoperfusion 21% 22% 70% 60%
- 18. IABP in Acute MI JACC 1985
- 25. Combined IABP and Thrombolysis GUSTO-I : IABP in 62 of the 310 lytic Rxâd Pts. in shock Observational Data:
- 27. Combined IABP and Thrombolysis Observational Data from SHOCK Registery :
- 28. Combined IABP and Thrombolysis - Barron, et.al., AHJ June 2001 -National Registry of MI-2, Data base -21,178 pts. Presenting with or developing post-MI shock -32% Received IABP P<0.001 P=NS TT TT IABP PPTCA PPTCA IABP The younger pts., twice as likely to get TT => Selection Bias
- 38. SHOCK Trial: Subgroup analysis, Age less than 75 Revasc. Med Rx P=0.02 CI<1.0 P=0.002 CI<1.0 Mortality 45% 65% 41% 56% 66.7% 48.4% P<0.02 CI<1.0
- 45. Role of IIb/IIIa Inhibitors and Stents in Cardiogenic Shock Thirty day Mortality Rates (%) Stent+ Reopro Stent Only PTCA+ Reopro PTCA Only Absence of Stent use : HR 2.39, 95% CI 1.22 to 4.67, p = 0.01 Absence of Abciximab use : HR 1.95, 95% CI 1.03 to 3.71, p = 0.04 On Univariate analysis : EF <=30% HR 3.44, 95% CI 1.35 to 8.78, p = 0.01
- 49. Role of IIb/IIIa Inhibitors and Stents in Cardiogenic Shock No Reopro With Reopro
- 50. Role of IIb/IIIa Inhibitors and Stents in Cardiogenic Shock Multivariate Analysis
Editor's Notes
- Not much data to support the last item
- MUST CLARIFY MEAN, SYSTOLIC, OR DIASTOLIC?????
- LAUNDRY list
- Patients with SHOCK were specifically excluded
- NEED THIS STUDY TO SEE WHAT THE LYTIC AGENT WAS?????
- Lower 1 yr mortality 67% v.s. 57% p=.04 Lowevr 30 day mortality 47.5 v.s. 60%, Increased bleedind complications however
- MAY take time, but try to make the RT hand data appear later using print screen etc. OR more to the point just leave it out for the time being to not confuse the matter and bring it up later in the discussion
- THEY WENT ON TO ACKNOWLEDGE THE DIFFICULTY OF PERFORMING SUCH A STUDY DUE TO PHYSICIAN BIAS, AND THE DIFFICULTY OF OBTAINING CONSENT IN THE CRITICALLY ILL PATIENTS.
- IT is clear that some Who received IABP did not receive TT nor went on to revasculariztion. These pt.s based on what has been presented so far are the ones who had no mortality benefit from placement of the IABP.
- 12 month results reported January of 2001.
- UNIVARIATE analysis only