Aggressive Treatment Can Extend Life of Patients with Heart Attack Shock

ized cardiogenic shock
care. Tertiary-care hospitals
patients who quickly
provide such specialized
receive invasive treatment.
services as heart catheteri-
Aggressive Treatment The study, published in a
zation and angioplasty,
recent issue of the Journal
which involves threading a
Can Extend Life of the American Medical
catheter-tipped balloon to
Association, shows that with
the site of a blockage in a
of Patients with invasive treatment, 33 per- coronary artery.
cent of hospitalized heart
Only about 60 percent of
Heart Attack Shock attack patients with cardio- shock patients younger
genic shock were alive six
than 75 received aggressive
years afterwards. By com-
forms of treatment in terti-
parison, only
ary-care centers in 2004,
DESPITE ADVANCES in treat-
20 percent of
according to a previous
ment, people who suffer a
those treated
study by Dr. Hochman and
heart attack, survive the
initially with
her colleagues. And only 38
first hit, and get to a hospi-
medications
percent of shock patients
tal still remain in danger.
and a device to
were transferred to such
Almost one in 10 will devel-
support the cir- centers from 1998 to 2001.
op cardiogenic shock, in
culation, called
The latest report from
which the heart malfunc-
an intra-aortic
Dr. Hochman’s group stems
tions, causing an inade-
balloon pump
from an international trial
quate amount of blood to
(IABP), sur-
funded by the National
be pumped to the vital
vived long-
Heart, Lung, and Blood
organs. As blood pressure
term.
Institute. It enrolled 302
plummets, the skin
“Our study
patients between 1993 and
becomes cool and the
shows a signifi-
1998 at 29 tertiary care cen-
body’s organs shut down.
cant survival
ters. All were initially treat-
Cardiogenic shock is the
benefit that is
ed with medications and
leading cause of death for
sustained up to
IABP to support the circu-
heart attack patients once
11 years,” says
lation and half received
they reach the hospital.
TERTIARY CARE HOSPITALS LIKE NYU MEDICAL
Dr. Hochman,
immediate angioplasty or
A study published in 1999
CENTER HAVE THE SOPHISTICATED INVASIVE
who is also the
bypass surgery.
by a group of researchers
CARE FACILITIES AND EXPERTISE FOR THE
Harold Snyder
In light of the new study,
AGGRESSIVE TREATMENT OF CARDIOGENIC
led by Judith S. Hochman,
SHOCK PATIENTS. THE IMAGES OF THE CORO-
Family Professor
Dr. Hochman hopes that
M.D., Clinical Chief of the
NARY ARTERIES (ABOVE) ARE FROM CATHETERI-
of Cardiology.
more patients with cardio-
ZATION, AN ADVANCED INVASIVE PROCEDURE.
Leon H. Charney Division
“This benefit
genic shock will be treated
of Cardiology and Director
receive aggressive therapy
extends even to selected
aggressively, and she
of Cardiovascular Clinical
at tertiary-care hospitals,
patients over the age of 75.
already sees some progress.
Research at NYU School of which have sophisticated
Patients can do very well
The New York State
Medicine, showed that
invasive-care facilities
and clearly benefit from
Department of Health
aggressive care with inva-
required for this kind of
this therapy, but many doc-
recently began a two-year
sive treatments, such as
therapy. Moreover, most
tors are reluctant to treat
experiment in which heart
angioplasty or open-heart
patients who reach a hospi-
these shock patients
attack patients with severe
surgery, could extend life
tal without such facilities
aggressively because they
cardiogenic shock will be
for at least one year. On the are not transferred to one
are the sickest of the sick.
separated from the public
basis of that study, the
where they can be treated
The death rate is so high.”
databases. This means that
American Heart Assoc-
appropriately.
Another problem is that
such patients’ mortality
iation and the American
Now, a new study by Dr.
some doctors are also reluc- rates will not reflect on
College of Cardiology rec-
Hochman’s group demon-
tant to put shock patients
their physicians’ records,
ommended that heart
strates that the long-term
into an ambulance and
encouraging more of their
attack shock patients be
survival benefit is even
transfer them to tertiary-
doctors to perform angio-
.
treated aggressively. Still,
greater than originally
care centers, where they
plasty and surgery.
not all eligible patients
believed for some hospital-
can receive appropriate
—Marjorie Shaffer
N Y U P H Y S I C I A N / F A L L 2 0 0 6 1 1

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