The American journal of cardiology
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Comparative Study
von Willebrand factor, fibrinogen, and soluble P-selectin levels after mitral valve replacement versus mitral valve repair.
Patients with mitral valve disease undergoing surgery are at an increased risk of thromboembolism. We hypothesized that this may be due in part to abnormalities in platelet activation, endothelial damage or dysfunction, and plasma fibrinogen in such patients. To test this hypothesis, we measured indexes of platelet activation (soluble P-selectin), endothelial damage or dysfunction (von Willebrand factor [vWf], enzyme-linked immunosorbent assay) and fibrinogen (modified Clauss) in 56 consecutive patients (35 women, mean age 65 years) admitted for isolated mitral valve repair (n = 39) or replacement (using mechanical implants, n = 17). ⋯ There was a significant negative correlation (Spearman, r = -0.4, p = 0.003) in postoperative plasma vWf levels and the size of valve prosthesis used. Thus, patients with mitral valve disease have increased plasma vWf levels when compared with healthy controls, suggesting endothelial damage or dysfunction, with a further increase in levels after mitral valve replacement. Conversely, patients undergoing mitral valve repair do not demonstrate any significant changes in fibrinogen, or indexes of endothelial dysfunction or platelet activation.
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Comparative Study
Effect of early revascularization on mortality from cardiogenic shock complicating acute myocardial infarction in California.
Recent retrospective analyses of treatment of cardiogenic shock suggest that early revascularization reduces mortality. All nonfederal hospital admissions in California for 1994 with a diagnosis of acute myocardial infarction (AMI) were identified. From that cohort, patients who developed cardiogenic shock were selected to determine demographic features, procedure utilization, and outcomes of their admission compared with patients with AMI without cardiogenic shock. ⋯ Overall in-hospital mortality for patients with shock was 56%. Patients referred for early revascularization had more favorable risk profiles, but after multivariate analysis early revascularization remained a powerful, independent predictor of improved survival, reducing the odds of death by 80%. This population-based study suggests that early revascularization may improve in-hospital survival of patients with cardiogenic shock complicating AMI, even after adjustment for baseline differences between patients who underwent early revascularization and those who did not.