Myocardial infarction (ST-elevation)
1Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Insights
This systematic review examines treatments for acute myocardial infarction (MI) and cardiogenic shock. It evaluates interventions like ACE inhibitors, beta-blockers, and revascularization to improve patient outcomes and reduce mortality.
Area of Science:
- Cardiology
- Critical Care Medicine
Background:
- Acute myocardial infarction (MI) has a high mortality rate, with a significant proportion of deaths occurring within the first hour.
- Cardiogenic shock post-MI affects over 5% of survivors, carrying a 50-80% mortality within 48 hours.
Purpose of the Study:
- To systematically review treatments that improve outcomes in acute myocardial infarction (MI).
- To identify treatments enhancing outcomes for patients experiencing cardiogenic shock after MI.
Main Methods:
- A systematic literature review was conducted, searching major databases up to August 2007.
- Included studies comprised systematic reviews, randomized controlled trials (RCTs), and observational studies.
- GRADE evaluation assessed the quality of evidence for various interventions.
Main Results:
- Fifty systematic reviews, RCTs, and observational studies met the inclusion criteria.
- Evidence quality for interventions was evaluated using the GRADE system.
- The review synthesizes data on a wide range of therapeutic interventions.
Conclusions:
- The review presents findings on the effectiveness and safety of numerous interventions for acute MI and cardiogenic shock.
- Interventions evaluated include ACE inhibitors, beta-blockers, revascularization, thrombolysis, and mechanical support devices.
- This comprehensive review aids in understanding current treatment options for acute MI and its complications.
Introduction:
About a quarter of people having an acute myocardial infarction (MI) in the USA will die of it, half of them within 1 hour of the onset of symptoms. Cardiogenic shock develops in over 5% of people surviving the first hour after an acute MI, with a mortality of 50-80% in the first 48 hours.
Methods And Outcomes:
We conducted a systematic review and aimed to answer the following clinical questions: Which treatments improve outcomes in acute MI? Which treatments improve outcomes for cardiogenic shock after MI? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
Results:
We found 50 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
Conclusions:
In this systematic review we present information relating to the effectiveness and safety of the following interventions: angiotensin-converting enzyme (ACE) inhibitors, aspirin, beta-blockers, calcium channel blockers, early cardiac surgery, early invasive cardiac revascularisation, glycoprotein IIb/IIIa inhibitors, intra-aortic balloon counterpulsation, nitrates (with or without thrombolysis), positive inotropes, primary percutaneous transluminal coronary angioplasty (PTCA), pulmonary artery catheterisation, thrombolysis (with or without low molecular weight heparin, with or without unfractionated heparin), vasodilators, and ventricular assistance devices and cardiac transplantation.
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