Cardiogenic Shock - NT Cardiovascular Center：心源性休克- NT心血管中心.pptVIP

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Cardiogenic Shock - NT Cardiovascular Center：心源性休克- NT心血管中心.ppt

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* 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 TACTICS ST elevation MI patients, presenting within 12 hours of Sx, and Cardiogenic shock 57 Patients were randomized Thrombolytic Therapy alone Thrombolytic Therapy + IABP TACTICS The primary endpoint of 6 month mortality was not statistically significant, P=0.3 Subgroup analysis: For KILLIP classes III and IV, P=0.07 PATIENT IS IN SHOCK w/ ST elevations, and 12 hrs Sx onset IABP Pressors May increase the efficacy of Lytics Administration of Lytics should not be delayed in anticipation of placement of IABP despite lack of randomized data proving efficay. If EARLY REVASCULARIZATION is not to be pursued: SHOCK Trial Whether EARLY REVASCULARIZATION improves survival among patients with cardiogenic shock? SHOCK Trial 302 Pts. with ST elevation (or new LBBB) and cardiogenic shock Immediate Revascularization (CABG/PTCA) Late revascularization (if indicated) deferred for at least 54 hours Within 36 hrs. of MI onset Within 12 hrs. of Shock onset SHOCK Trial: Primary end point, 30 days mortality Diff.=9% P=0.11 47% 56% Mortality Diff.=13% P=0.027 50% 63% 52.4% 66.4% Diff.=14% P0.02 Revasc. Med Rx SHOCK TrialWhy wasn’t the Primary end-point met? Low mortality in the initial medical mgt gp. High rates of IABP use, 86% TT use, 63% Delayed revasculariztion, 21% Median of 104 hrs post randomization 30 days mortality 47% 56% SHOCK Trial: Subgroup analysis, Age less than 75 Revasc. Med Rx P=0.02 CI1.0 P=0.002 CI1.0 Mortality 45% 65% 41% 56% 66.7% 48.4% P0.02 CI1.0 SHOCK Trial: What to do with