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《Revista espa?ola de cardiología》2023,76(9):719-728
Introduction and objectivesCurrent guidelines do not recommend routine thrombus aspiration in acute myocardial infarction (AMI) because no benefits were observed in previous randomized trials. However, there are limited data in cardiogenic shock (CS) complicating AMI.MethodsWe included 575 patients with AMI complicated by CS. The participants were stratified into the TA and no-TA groups based on use of TA. The primary outcome was a composite of 6-month all-cause death or heart failure rehospitalization. The efficacy of TA was additionally assessed based on thrombus burden (grade I-IV vs V).ResultsNo significant difference was found in in-hospital death (28.9% vs 33.5%; P = .28), or 6-month death, or heart failure rehospitalization (32.4% vs 39.4%; HRadj: 0.80; 95%CI, 0.59-1.09; P = .16) between the TA and no-TA groups. However, in 368 patients with a higher thrombus burden (grade V), the TA group had a significantly lower risk of 6-month all-cause death or heart failure rehospitalization than the no-TA group (33.4% vs 46.3%; HRadj: 0.59; 95%CI, 0.41-0.85; P = .004), with significant interaction between thrombus burden and use of TA for primary outcome (adjusted Pint = .03).ConclusionsRoutine use of TA did not reduce short- and mid-term adverse clinical outcomes in patients with AMI complicated by CS. However, in select patients with a high thrombus burden, the use of TA might be associated with improved clinical outcomes. The study was registered at ClinicalTrials.gov (Identifier: NCT02985008). 相似文献
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Noemí Esparza Martín Araceli Hernández Betancor Yaiza Rivero Viera Saulo Fernández Granados Santiago Suria González Rita Guerra Rodríguez Germán Pérez Suárez Ingrid Auyanet Saavedra Agustín Toledo González José Luis Pérez Arellano César García Cantón 《Nefrología : publicación oficial de la Sociedad Espa?ola Nefrologia》2019,39(2):213-216
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Mössner J 《Der Internist》2005,46(9):974-981
Acute abdomen is not a disease entity on its own but describes a critical state of the patient which can be caused by numerous diseases. The surgeon and internist have to apply an interdisciplinary approach to enable a rapid decision on whether immediate laparotomy is mandatory. Few appropriate diagnostic procedures support decision making. In many cases there is an indication for immediate surgery, such as perforated gastric or duodenal ulcer, acute appendicitis, diverticulitis, ruptured aortic aneurysm, mechanic ileus, infarction of the mesenteric artery. This review is mainly focused on diseases which may present as acute abdomen but for which surgery is usually not indicated, such as acute pancreatitis. Furthermore, one also has to consider rare diseases in which laparotomy would clearly be a mistake, such as acute intermittent porphyria or intestinal pseudo-obstruction. 相似文献
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Visco JJ Raghavendran K Kulaylat MN Wexner SD 《Diseases of the colon and rectum》2003,46(11):1572-3; author reply 1573