Résumé
Background: Acute myocardial infarction (AMI) complicated with cardiogenic shock is still associated with a significant death rate. Other interventions, including intra-aortic balloon counter pulsation and medical therapy, failed to improve prognosis in large-scale randomised studies, with the exception of early revascularization. Recently, mild therapeutic hypothermia, in which patients are lowered to 33°C over the course of 24 hours, has been proposed as a therapy option for cardiogenic shock patients. The purpose of this study is to determine the impact of mild hypothermia on morbidity and mortality associated with post-AMI cardiogenic shock. Methods: This randomized, controlled, unblinded trial was conducted on 50 patients with AMI complicated by CS. Patients were randomly allocated into two equal groups; group I received MTH to 33°C for 24-36 h and group II (control group) did not receive MTH. Patients were subjected to full history taking, general and clinical examination, laboratory examination, echo, chest ultrasound (US), coronary angiography data and mild therapeutic hypothermia protocol. Results: Stroke until day 30, duration of mechanical ventilation, length of ICU stay, duration of inotropic support, mortality and pulmonary congestion by US were insignificantly different between both groups. Arterial lactate and mean arterial blood pressure (MAP) at 4h, 6h, 8h, 10h, 12h, 14h, 16h, 18h, 20h were significantly increased in group I than Group II (P value<0.05). and were insignificantly different between both groups at 0h, 2h, 22h, 24h, 26h, 28h, 30h. Serum creatinine at 24h, 48h was significantly increased in group I than Group II (p value <0.05) and was insignificantly different between both groups at 0h. Conclusions: Therapeutic hypothermia (TH) didn’t improve short term outcomes in patients with post AMI cardiogenic shock.
Résumé
Background: Around 20% of percutaneous coronary interventions (PCIs) are used to treat coronary bifurcation syndromes. Technical success was defined as successfully bridging the occluded portion with a wire and balloon and reopening the artery with a 40% residual stenosis in all views. Technical success is defined by the absence of a serious adverse cardiac event throughout the hospital stay (MACE). The purpose of this study was to evaluate the procedural and clinical results associated with LM bifurcational intervention. Methods: A controlled study was carried out on 100 patients eligible to Left Main bifurcational intervention were included. the patients were divided into two groups according to the stenting technique used, the provisional group (n=70) who managed with one stent strategy, and the non-provisional group (n=30) who managed with a double kissing crush, culotte, T stenting, or TAP technique. This study recorded the incidence of MACE: death, non-fatal myocardial infarction, or target lesion revascularizations were recorded at 6 and 12 months of follow-up. Results: It is insignificantly different mortality incidence between the 2 groups but non-fatal myocardial infarction, stent thrombosis, re-PTCA, and target lesion revascularizations were significantly increased in the non-provisional group. As regards clinical success in 2 groups, this study found 68 patients in the provisional group and 24 patients in the non-provisional group fulfilled the characteristics of clinical success. Conclusions: In LM-bifurcational intervention, there is a significant increase in the incidence of MACE in the non-provisional group and so the clinical outcome is better in the provisional stenting than the non-provisional stenting.