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| Description
| - Clinical data on optimal management of mechanical complications of myocardial infarction are lacking. We retrospectively evaluated the effect of intra-aortic balloon pump (IABP) on 30-day survival in patients with postinfarction ventricular septal rupture (VSR, n = 55) or acute mitral regurgitation (MR, n = 26) who developed either cardiogenic shock (n = 46) or severe hemodynamic instability that did not fulfill the criteria of shock (n = 35). IABP was inserted in 83% of the patients with shock and 57% of those without shock. Thirty-five (76%) patients with shock and all unstable patients survived until surgical repair, which was performed within a median (interquartile range) of 1 (1 to 2) and 9 (2 to 18) days from the onset of the complication (p < 0.001). All patients who did not undergo the operation died within 3 days. Although MR presented more acutely, the patients' outcomes were similar to those with VSR. IABP support reduced 30-day mortality in the patients with shock (61% vs 100%, p = 0.04) but not in the patients without shock (20% vs 27%, p = 0.7). The benefit of IABP support in the shock cohort was driven mainly by reduction of preoperative mortality (11% vs 88%, p < 0.001). Early progression of cardiogenic shock and unperformed surgery were the only independent predictors of 30-day mortality (hazard ratio 3.4, 95% confidence interval 1.5 to 8 and hazard ratio 5.1, 95% confidence interval 2.2 to 11, respectively; p = 0.004 and p < 0.001, respectively). In conclusion, we suggest that all patients with postinfarction VSR or acute MR with signs of cardiogenic shock should immediately receive IABP as a bridge to emergent surgical repair. In contrast, hemodynamically unstable patients without shock may be first stabilized by medical therapy, without additional benefit of IABP, before they undergo cardiac surgery.
- Clinical data on optimal management of mechanical complications of myocardial infarction are lacking. We retrospectively evaluated the effect of intra-aortic balloon pump (IABP) on 30-day survival in patients with postinfarction ventricular septal rupture (VSR, n = 55) or acute mitral regurgitation (MR, n = 26) who developed either cardiogenic shock (n = 46) or severe hemodynamic instability that did not fulfill the criteria of shock (n = 35). IABP was inserted in 83% of the patients with shock and 57% of those without shock. Thirty-five (76%) patients with shock and all unstable patients survived until surgical repair, which was performed within a median (interquartile range) of 1 (1 to 2) and 9 (2 to 18) days from the onset of the complication (p < 0.001). All patients who did not undergo the operation died within 3 days. Although MR presented more acutely, the patients' outcomes were similar to those with VSR. IABP support reduced 30-day mortality in the patients with shock (61% vs 100%, p = 0.04) but not in the patients without shock (20% vs 27%, p = 0.7). The benefit of IABP support in the shock cohort was driven mainly by reduction of preoperative mortality (11% vs 88%, p < 0.001). Early progression of cardiogenic shock and unperformed surgery were the only independent predictors of 30-day mortality (hazard ratio 3.4, 95% confidence interval 1.5 to 8 and hazard ratio 5.1, 95% confidence interval 2.2 to 11, respectively; p = 0.004 and p < 0.001, respectively). In conclusion, we suggest that all patients with postinfarction VSR or acute MR with signs of cardiogenic shock should immediately receive IABP as a bridge to emergent surgical repair. In contrast, hemodynamically unstable patients without shock may be first stabilized by medical therapy, without additional benefit of IABP, before they undergo cardiac surgery. (en)
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| Title
| - Utility of intra-aortic balloon pump support for ventricular septal rupture and acute mitral regurgitation complicating acute myocardial infarction
- Utility of intra-aortic balloon pump support for ventricular septal rupture and acute mitral regurgitation complicating acute myocardial infarction (en)
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| skos:prefLabel
| - Utility of intra-aortic balloon pump support for ventricular septal rupture and acute mitral regurgitation complicating acute myocardial infarction
- Utility of intra-aortic balloon pump support for ventricular septal rupture and acute mitral regurgitation complicating acute myocardial infarction (en)
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| skos:notation
| - RIV/00023001:_____/13:00058734!RIV14-MZ0-00023001
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| http://linked.open...avai/riv/aktivita
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| http://linked.open...avai/riv/aktivity
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| http://linked.open...iv/cisloPeriodika
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| http://linked.open...vai/riv/dodaniDat
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| http://linked.open...aciTvurceVysledku
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| http://linked.open.../riv/druhVysledku
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| http://linked.open...iv/duvernostUdaju
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| http://linked.open...titaPredkladatele
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| http://linked.open...dnocenehoVysledku
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| http://linked.open...ai/riv/idVysledku
| - RIV/00023001:_____/13:00058734
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| http://linked.open...riv/jazykVysledku
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| http://linked.open.../riv/klicovaSlova
| - operation; guidelines; heart; management; repair; surgery; defect; papillary-muscle; cardiogenic-shock; shock trial registry (en)
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| http://linked.open.../riv/klicoveSlovo
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| http://linked.open...odStatuVydavatele
| - US - Spojené státy americké
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| http://linked.open...ontrolniKodProRIV
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| http://linked.open...i/riv/nazevZdroje
| - American Journal of Cardiology
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| http://linked.open...in/vavai/riv/obor
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| http://linked.open...ichTvurcuVysledku
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| http://linked.open...cetTvurcuVysledku
| |
| http://linked.open...UplatneniVysledku
| |
| http://linked.open...v/svazekPeriodika
| |
| http://linked.open...iv/tvurceVysledku
| - Kautzner, Josef
- Pirk, Jan
- Kettner, Jiří
- Šramko, Marek
- Holek, Martin
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| http://linked.open...ain/vavai/riv/wos
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| issn
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| number of pages
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| http://bibframe.org/vocab/doi
| - 10.1016/j.amjcard.2013.07.035
|
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