Acute Ischemic Heart Disease
The use of intra-aortic balloon counterpulsation in patients with cardiogenic shock complicating acute myocardial infarction: Data from the National Registry of Myocardial Infarction 2,☆☆,

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Abstract

Background Cardiogenic shock complicating acute myocardial infarction (AMI) remains the leading cause of death in patients hospitalized with AMI. Although several studies have demonstrated the importance of establishing and maintaining a patent infarct-related artery, it remains unclear as to whether intra-aortic balloon counterpulsation (IABP) provides incremental benefit to reperfusion therapy. The purpose of this study was to determine whether IABP use is associated with lower in-hospital mortality rates in patients with AMI complicated by cardiogenic shock in a large AMI registry. Methods We evaluated patients participating in the National Registry of Myocardial Infarction 2 who had cardiogenic shock at initial examination or in whom cardiogenic shock developed during hospitalization (n = 23,180). Results The mean age of patients in the study was 72 years, 54% were men, and the majority were white. The overall mortality rate in all patients who had cardiogenic shock or in whom cardiogenic shock developed was 70%. IABP was used in 7268 (31%) patients. IABP use was associated with a significant reduction in mortality rates in patients who received thrombolytic therapy (67% vs 49%) but was not associated with any benefit in patients treated with primary angioplasty (45% vs 47%). In a multivariate model, the use of IABP in conjunction with thrombolytic therapy decreased the odds of death by 18% (odds ratio, 0.82; 95% confidence interval, 0.72 to 0.93). Conclusions Patients with AMI complicated by cardiogenic shock may have substantial benefit from IABP when used in combination with thrombolytic therapy. (Am Heart J 2001;141:933-9.)

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Data sources

NRMI 2 is a prospective, observational study sponsored by Genentech, Inc (South San Francisco, Calf). NRMI 2, which was initiated in June 1994, contains data abstracted from the charts of patients with AMI admitted to registry hospitals. The completed case report form is forwarded from the registry hospital to an independent central data collection center (ClinTrials Research, Inc, Lexington, Ky) for processing and analysis. The data collection center used double-key entry to add data from each

Results

By using data from NRMI 2, we identified 23,180 patients with AMI complicated by cardiogenic shock. The baseline demographic and clinical characteristics of this population are shown in Table I.

. Baseline demographics and clinical characteristics of patients with cardiogenic shock

Patient characteristics (n = 23,180)Empty Cell
Age (y)71.9
Male sex53.7%
White race87.1%
History of
 Diabetes31%
 Hypertension48%
 Angina20%
 CHF20%
 MI28%
 Stroke11%
 PTCA6%
 CABG12%
Chest pain on arrival62%
Killip class IV on arrival25%
ST

Discussion

In this study, we made several important observations regarding the treatment and outcome of patients with AMI complicated by cardiogenic shock. First, the mortality rate in patients with cardiogenic shock remains exceedingly high (70%) and does not appear to have significantly changed over time. In a community-based study in Worcester, Massachusetts, Goldberg et al3 found that the overall in-hospital mortality rate of patients with AMI complicated by cardiogenic shock was 78% and was constant

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Supported in part by a grant from Datascope Corp, Montiale, NJ, and Genentech Inc, South San Francisco, Calif.

☆☆

Reprint requests: Hal V. Barron, MD, 1 DNA Way, South San Francisco, CA 94080. E-mail: [email protected]

The first author, Hal V. Barron, is an employee of Genentech Inc, South San Francisco, Calif.

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