A pooled analysis in cardiogenic shock due to acute coronary syndromes is desirable to assess the effect of early revascularization (ERV) across all ages and a wide spectrum of disease severity

Antman EM

Berger AK

Berger PB

Califf RM

Chi-Hong Tseng

Dauerman HL

Dreyfuss D

Druml C

Dzavik V

Harvey SE

Hasdai D

Hibbard MD

Hochman JS

Hollenberg SM

Holmes DR

Jean-Christophe Stauffer

Judith S. Hochman

Lee L

Lynn A. Sleeper

Matthias E. Pfisterer

Menon V

Moosvi AR

Norell MS

O'Neill WW

Philip Urban

Raban V. Jeger

Shannon M. Harkness

Thierry H. Lejemtel

Urban P

Walters MI

Williams SG

PubMed

BACKGROUND: A pooled analysis in cardiogenic shock due to acute coronary syndromes is desirable to assess the effect of early revascularization (ERV) across all ages and a wide spectrum of disease severity.
METHODS: Only two randomized controlled trials (RCT), i.e. SMASH and SHOCK, met the inclusion criteria and were combined for a pooled analysis using individual patient data (n = 348).
RESULTS: SMASH patients (n = 54, 16%) had more severe disease than SHOCK patients (n = 294, 84%). After adjustment for age, anoxic brain damage, non-inferior myocardial infarction, prior coronary artery bypass graft surgery, renal failure, systolic blood pressure, and selection for coronary angiography, one-year mortality was similar (relative risk SHOCK versus SMASH 0.87, 95% CI: 0.61-1.25). Relative risk of one-year death for ERV versus initial medical stabilization was 0.82 (95% CI: 0.70-0.96). There was no significant difference in the treatment effect by age (≤75 years relative risk at one year 0.79, 95% CI: 0.63-0.99; &gt; 75 years relative risk at one year 0.93, 95% CI: 0.56-1.53; interaction P = 0.10).
CONCLUSIONS: Only two RCT have been published emphasizing the difficulty of enrolling critically ill patients. Despite large differences in shock severity, ERV benefit is similar across all ages and not significantly different for the elderly

Jeger, R.V.

Urban, P.

Harkness, S.M.

Tseng, C.H.

Stauffer, J.C.

Lejemtel, T.H.

Sleeper, L.A.

Pfisterer, M.E.

Hochman, J.S.

Serveur académique lausannois

Early revascularization is beneficial across all ages and a wide spectrum of cardiogenic shock severity: A pooled analysis of trials

Jeger, Raban V.

Urban, Philip

Harkness, Shannon M.

Tseng, Chi-Hong

Stauffer, Jean-Christophe

Lejemtel, Thierry H.

Sleeper, Lynn A.

Pfisterer, Matthias E.

Hochman, Judith S.

edoc

Early revascularization is beneficial across all ages and a wide spectrum of cardiogenic shock severity : a pooled analysis of trials

Crossref

Acute Cardiac Care

http://dx.doi.org/10.3109/17482941.2010.538696

Early revascularization is beneficial across all ages and a wide spectrum of cardiogenic shock severity : a pooled analysis of trials

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Serveur académique lausannois

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