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PCI, CABG for cardiogenic shock.

Both percutaneous coronary interventions and coronary artery bypass grafting are seriously underused in patients with MI complicated by cardiogenic shock, according to a nationwide survey.

The American College of Cardiology and the American Heart Association revised their guidelines in 1999, elevating early mechanical intervention for cardiogenic shock to a class I recommendation for patients younger than 75 with an ST-elevation left bundle-branch block acute MI. However, a national database that has tracked practice patterns and MI out-comes since 1990 showed that physicians have been slow to comply with this change and had only marginally increased the use of PCI and CABG in this patient group by early 2004, said Anvar Babaev, M.D., of New York University, New York, and colleagues (JAMA 2005;294:448-54).

The database included nearly 300,000 MI patients treated at 775 hospitals with revascularization capability. Of these patients, more than 25,000 (8.6%) had cardiogenic shock. Mortality clearly decreased with increasing use of revascularization, illustrating the benefit of early mechanical intervention. But it appears that physicians may still be reluctant to try these interventions in high-risk patients, the investigators said.
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Title Annotation:CLINICAL CAPSULES; percutaneous coronary interventions; coronary artery bypass grafting
Author:Moon, Mary Ann
Publication:Internal Medicine News
Article Type:Brief Article
Geographic Code:1USA
Date:Oct 1, 2005
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