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Least 40% of the left ventricular myocardium.7 ; Based on data from the SHOCK trial and registry and other databases, current guideline recommendations for the treatment of CS include intra-arterial blood pressure monitoring, pulmonary artery catheterization, echocardiography for the detection of mechanical MI complications such as papillary muscle rupture or free wall ventricular rupture, intra-aortic balloon counter pulsation, emergency revascularization, and percutaneous coronary intervention for all patients less than 75 years of age. Revascularization is recommended in selected patients older then 75.8 ; A large nonrandomized cooperative study showed that IABP counter-pulsation alone without adjunctive percutaneous coronary angioplasty or CABG surgery did not reduce mortality rate, which was 83%.9 ; An early revascularization in CS has a lower rate of deterioration than the initial medically stabilized patients.10 ; Many studies did show better long-term survival in patients with CS treated with early revascularization than with only medical management.11, 12 ; Patients in CS with triple vessel disease or left main are unsuitable for PTCA; thus CABG is preferred as an alternative. Pooled data from 25 nonrandomized studies involving 391 patients in CS who underwent CABG revealed a 35% hospital mortality rate.13 ; Our study showed a lower mortality rate of 16% of patients with CS, which is lower then the previous studies. The reason for low mortality may be related to using antegrade and retrograde warm blood cardioplegia and the single-clamp technique for proximal and distal anastomoses.1416 ; Although in the GUSTO Global Utilization of Streptokinase and Tissue-plasminogen activator for Occluded coronary arteries ; trial VS rupture was detected as an independent predictor of a worse prognosis or death, 17 ; and the SHOCK trial revealed 87% mortality with VS rupture, 18 ; 2 of our patients operated on for postinfarct VS defect repair survived and remained stable after 24 months of surgery. Eighty-two percent of our patients were in NYHA class I or II year after their operation. Functional class improvement was also evident in other studies.19 ; We concluded that CABG in patients with CS contributed to lowering mortality in the hospital to a significant 1-year survival rate and to improvement in the functional class. Therefore CABG should be offered to those selected patients with post-MI CS where primary PCI is not possible or is contraindicative for anatomical reasons and disopyramide.
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1. Freeland B, Paglia R, Seal D. Clinical challenges of type B insulin resistance: a case study. The Diabetes Educator. 1998; 24: 728 Boden G. Pathogenesis of type 2 diabetes. Insulin resistance. Endocrinol Metab Clin North Am. 2001; 30: 801 Grumback R, Dlarsen S. Puberty, ontogeny, neuroendocrinology, physiology, and disorders. In: Williams textbook of endocrinology. 10th ed. Philadelphia: W.B. Saunders. 2003; pp 1146 1147. 4. Lopez-Penabad L, Case C, D'Amico S, Balasubramanyam A, Maldonado, M. Grand rounds in endocrinology, diabetes, and metabolism from Baylor College of Medicine: new-onset diabetes in a 61-year-old woman. Medscape Diabetes Endocrinol online serial ; . 2002; 4 1 ; . 5. Arioglu E, Andewelt A, Diabo C, Bell M, Taylor SI, Gorden P. Clinical course of the syndrome of autoantibodies to the insulin receptor type B insulin resistance ; : a 28-year perspective. Medicine Baltimore ; . 2002; 81: 87100. continued on page 11.
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