Journal of the American College of Cardiology
-
J. Am. Coll. Cardiol. · Apr 1992
Early revascularization improves survival in cardiogenic shock complicating acute myocardial infarction.
The effects of coronary revascularization by percutaneous transluminal coronary angioplasty or coronary bypass grafting, or both, on survival were evaluated in 81 patients with cardiogenic shock complicating acute myocardial infarction. Thirty-two patients had successful revascularization and 49 patients had unsuccessful or no revascularization. Revascularization was achieved by coronary angioplasty in 22 patients, coronary bypass surgery in 2 and angioplasty followed by bypass surgery in 8. ⋯ At a mean follow-up period of 21 +/- 15 months, this survival difference persisted--16 (50%) of 32 patients with revascularization survived versus 1 (2%) of 49 patients without revascularization (p less than 0.0001). The mean time from the onset of shock to revascularization differed significantly between survivors (12.4 +/- 15 h) and nonsurvivors (58.5 +/- 93 h) in the group with revascularization (p = 0.0004). In the revascularization group, the in-hospital survival rate was 77% (17 of 22) when revascularization was performed within 24 h but only 10% (1 of 10) when it was performed after 24 h (p = 0.0006).(ABSTRACT TRUNCATED AT 250 WORDS)
-
J. Am. Coll. Cardiol. · Apr 1992
Randomized Controlled Trial Comparative Study Clinical TrialEffects of amiodarone versus quinidine and verapamil in patients with chronic atrial fibrillation: results of a comparative study and a 2-year follow-up.
Rapid, reliable and safe reestablishment of sinus rhythm is the major aim of pharmacologic treatment in patients with chronic atrial fibrillation. The mainstay of therapy in this arrhythmia has been quinidine. More recently, amiodarone was shown in non-comparative studies to be superior to class IA agents under certain conditions. ⋯ In addition, quinidine and verapamil had a characteristic "rate-smoothing" effect on atrioventricular conduction during atrial fibrillation. The rhythm was converted to sinus rhythm after quinidine in 5 (25%) of 20 patients and after the combination of quinidine and verapamil in 11 (55%) of 20 patients. Amiodarone restored sinus rhythm in 12 (60%) of 20 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
-
J. Am. Coll. Cardiol. · Apr 1992
Role of balloon atrial septostomy before early arterial switch repair of transposition of the great arteries.
Preoperative balloon atrial septostomy is the standard therapy for babies with uncomplicated cyanotic dextrotransposition of the great arteries despite the effectiveness of prostaglandin E1 infusion in alleviating systemic hypoxemia and the reported success of arterial switch repair during the 1st weeks after birth. The clinical records and echocardiographic findings of 23 infants (mean birth weight +/- SD 3.3 +/- 0.5 kg) with uncomplicated transposition of the great arteries were analyzed. Fifteen infants (Group I) did not undergo septostomy, and 8 (Group II) underwent septostomy. ⋯ Thus, the diameter of the foramen ovale was the primary factor influencing arterial oxygenation during prostaglandin infusion. Babies underwent the arterial switch operation at a mean age of 70 +/- 65 h with an overall survival rate of 96%; there was only one postoperative death (Group II). Absence of septostomy had no negative influence on any postoperative variable, including duration of ventilatory and inotropic support, time to discharge, or mortality.(ABSTRACT TRUNCATED AT 250 WORDS)