Emergency angioplasty or bypass surgery saves lives of heart attack patients with cardiogenic shock

Heart attack patients with a life-threatening complication called cardiogenic shock experience an improvement in survival at 6 months when treated with balloon angioplasty or coronary bypass surgery compared to patients who receive intensive medical care to stabilize their condition, according to a study funded by the National Heart, Lung, and Blood Institute (NHLBI).

The results of the SHOCK (Should we Emergently Revascularize Occluded Coronaries for Cardiogenic Shock) trial are published in the August 26 issue of The New England Journal of Medicine.

The investigators report that emergency "revascularization" with angioplasty or bypass surgery did not significantly reduce deaths of shock patients at 30 days (the primary end point of the study); however, after 6 months patients who had these procedures performed early had a 35 percent improvement in survival over patients who received intensive medical therapy, including clot-busting drugs. The improvement in survival was even greater-- 57 percent -- for patients under age 75 years.

"These results provide evidence that early treatment with bypass surgery or angioplasty can save the lives of heart attack patients with cardiogenic shock. Physicians should be strongly encouraged to consider emergency revascularization for these patients-- even if it means referring them to another hospital that is better equipped to handle these procedures," said NHLBI Director Dr. Claude Lenfant.

Each year an estimated 71,000 hospitalized heart attack patients develop cardiogenic shock. This complication is the leading cause of death in patients hospitalized for heart attack. Relatively few patients with cardiogenic shock are currently treated with emergency bypass surgery or angioplasty. Such patients are extremely ill and physicians may be reluctant to subject them to relatively risky procedures-- particularly since there has been conflicting evidence a

Contact: NHLBI Communications Office
NIH/National Heart, Lung, and Blood Institute

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