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Increased use of early revascularization in heart attack patients with cardiogenic shock will save lives

Revascularization (coronary angioplasty or coronary artery bypass graft surgery) within 6 hours of a heart attack complicated by cardiogenic shock increases survival rates. Although rare, cardiogenic shock is a dangerous complication of heart attack in which the heart is so damaged that it cannot pump enough blood to the body. In New York City, only certain hospitals have the capacity to perform revascularization. The possibility of early revascularization depends on admission to a hospital that has the capacity to perform this service.

According to a recent study, the number of patients who had this complication and were admitted to New York City hospitals with the capacity to perform revascularization increased modestly from 2000 to 2002 compared with 1995 to 1999. This seemed to be an ongoing trend rather than a reaction to the 1999 recommendation of early revascularization of such patients by the American College of Cardiology/American Heart Association (ACC/AHA), according to Jing Fang, M.D., and Michael H. Alderman, M.D., of the Albert Einstein College of Medicine. Their work was supported by the Agency for Healthcare Research and Quality (HS11612).

The researchers examined New York hospital discharge records before and after publication of the ACC/AHA guidelines to determine whether the rates of revascularization increased after publication of the guidelines and, if an increase occurred, whether it was due to increasing admission to hospitals with this capacity, to increased use of the procedure among patients who had been admitted to such hospitals, or a combination of the two factors.

Over the years, 58 percent of patients who suffered cardiogenic shock died during hospitalization compared with 8 percent of those with heart attack but not shock. For hospitals with revascularization services, the rates of revascularization did not increase from 1995 to 1999 or from 2000 to 2002. However, admissions to these hospitals increased from 54 to 61 percent from 1995 to 1999. The researchers conclude that the modest increase in these procedures from 1995 to 1999 and from 2000 to 2002 reflected a trend already underway before the ACC/AHA recommendation. Ambulance delivery directly to revascularizing hospitals or wider distribution of those facilities and increased performance of these procedures in such hospitals may improve adherence to ACC/AHA guidelines, note the researchers.

See "Revascularization among patients with acute myocardial infarction complicated by cardiogenic shock and impact of American College of Cardiology/American Heart Association guidelines," by Drs. Fang and Alderman, in the November 15, 2004, American Journal of Cardiology 94, pp. 1281-1285.

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