Disección coronaria espontánea: aspectos diagnósticos y terapéuticos / Spontaneous coronary dissection: diagnostic and therapeutic approach

Presentamos dos casos de disección espontánea coronaria, que corresponden a dos mujeres sin factores de riesgo que presentaron un síndrome coronario agudo que cursó con importantes cambios electrocardiográficos. Se realizó en ambos casos una coronariografía urgente, que demostró una disección del tronco de la coronaria izquierda en el primer caso y una disección del segmento proximal de la arteria descendente anterior en el segundo. Ambos casos fueron revascularizados quirúrgicamente. (AU)

[Coronary ischemia caused by pseudoxanthoma elasticum and myocardial revascularization with double arterial graft]. / Isquemia coronaria producida por seudoxantoma elástico y revascularización miocárdica con doble injerto arterial.

We present a case of an 18 year-old woman with pseudoxanthoma elasticum, who had a biopsy taken from a lesion. Although she was asymptomatic, we tried to rule out myocardial ischemia with a treadmill and cardiac gammagraphy with Talio. The isotopic studies and the ergometry were positive and the patient underwent coronariography. This study showed a severe triple-vessel disease. We did an angiography of the supraaortic arteries, mamarian artery, and mesenteric artery. These studies showed no obstructive lesions. The treatment of patient was a double by-pass with internal mammary artery and one by-pass with safena vein grafts with satisfactory results.

Infarto agudo de miocardio y trombosis coronaria inducidos por cocaína / Acute myocardial infarction and coronary thrombosis induced by cocaine

Un joven de 28 años con antecedentes de ulcus gástrico sufre un infarto agudo de miocardio anterolateral después de haber consumido en los días previos gran cantidad de cocaína. La coronariografía evidenció la presencia de un trombo oclusivo en el segmento proximal de la arteria descendente anterior, que se extendía hacia la porción distal del tronco de la coronaria izquierda. Se decidió realizar trombolisis intracoronaria con urocinasa. El trombo fue parcialmente lisado y la evolución posterior fue satisfactoria. En el control angiográfico se observaron unas arterias coronarias epicárdicas sin lesiones obstructivas (AU)

Role of transesophageal echocardiography in the assessment of patients with blunt chest trauma: correlation of echocardiographic findings with the electrocardiogram and creatine kinase monoclonal antibody measurements.

OBJECTIVES: This study was designed to evaluate the usefulness of transesophogeal echocardiography (TEE) for detecting cardiac damage after blunt chest trauma (BCT). BACKGROUND: Multiple methods have been used to detect cardiac damage after a BCT, but none has been demonstrated to be sensitive, specific, and feasible enough. METHODS: This multicenter prospective trial was designed to evaluate the usefulness of TEE in the assessment of patients with BCT and to compare the TEE findings with those provided by the electrocardiogram (ECG) and cardiac isoenzymes assay. One hundred seventeen consecutive patients with a significant BCT were enrolled. A TEE was performed in each patient. Serial ECGs and plasma profiles of creatine kinase (CK) and CK-monoclonal antibody (MB) were obtained. RESULTS: Sixty-six (56%) patients had pathologic findings in the TEE attributed to the BCT (group A). In the remaining 51 (44%) patients the TEE was normal (group B). An abnormal ECG was more frequent in group A (59% vs 24%; p < 0.001), and the serum CK-MB peak level was also higher in group A (174 +/- 30 U/L vs 93 +/- 21 U/L; p = 0.05). Relative to pathologic TEE findings, the sensitivity and specificity of an abnormal ECG were 59% and 73% and of high CK-MB with CK-MB/CK > 5% were 64% and 52%, respectively. CONCLUSIONS: We conclude that TEE can be routinely and safely performed for diagnosing cardiac injuries after a BCT and plays an important role in the evaluation and treatment of these patients. EGG and CK-MB assay are not good methods for detecting cardiac damage in this setting.

[Influence of systemic arterial hypertension on mid-term survival of patients with acute myocardial infarction treated with fibrinolytic agents]. / Influencia de la hipertensión arterial sistémica en la supervivencia a medio plazo de los pacientes con infarto agudo de miocardio que han recibido tratamiento fibrinolítico.

BACKGROUND: The purpose of this study to asses the effect of systemic arterial hypertension on mid-term survival of patients with acute myocardial infarction who received thrombolytic treatment. PATIENTS AND METHOD: We studied 202 consecutive patients with acute myocardial infarction, admitted in the Coronary Care Unit of the Hospital Xeral de Galicia who received intravenous thrombolytic therapy within six hours from the onset of symptoms. The thrombolytics used were: urokinase (79.7%), rt-PA (9.9%), streptokinase (4.9%) and APSAC (5.5%). Left heart catheterization with coronary angiography was performed in 162 patients at 2 weeks after infarction. Patency of the infarction-related artery (IRA) was classified according to Thrombolysis in Myocardial Infarction (TIMI) criteria. A patent artery weas defined as having TIMI grades 2 or 3 antegrade flow. RESULTS: Systemic arterial hypertension was found in 34.7% of patients. IRA patency (TIMI 2-3) was demonstrated in the 75.3% of the patients. Early mortality (first month) was 5.4%. Multivariate analysis identified cardiogenic shock as the only variable with independent predictive value for early mortality. Mean follow-up was for 24 +/- 19 months. Late mortality was 5.2% and cardiac death occurred in 4.2% of patients. Reinfarction occurred in 3.1% of patients. Congestive heart failure, arterial hypertension and reinfarction adversely affected prognosis. Actuarial survival at the end of follow-up period was significantly lower in patients with systemic arterial hypertension (70.4% vs 85.9%; p < 0.05). CONCLUSIONS: These data suggest that systemic arterial hypertension adversely affects mid-term prognosis in patients with acute myocardial infarction who received thrombolytic treatment.

[Left ventricular structure and (systolic and diastolic) function in hypertensive patients without atherosclerotic coronaropathy]. / Estructura y función (sistólica y diastólica) ventricular izquierda en hipertensos sin coronariopatía aterosclerosa.

INTRODUCTION AND OBJECTIVES: Electrocardiographic (ECG) ST-T segment abnormalities in hypertensive patients are traditionally associated with hypertrophy and/or ischaemia and a higher cardiovascular risk. Hypertensive patients with typical or non-typical chest discomfort and a normal coronarographic study underwent an echocardiographic and Doppler study in order to assess left ventricular structure and (systolic and diastolic) function. MATERIAL AND METHODS: Hypertensive patients with ST-T changes were classified as follows: Control group (CG) was made up of 12 hypertensive patients (6 women, 6 men, mean age 59.6 +/- 7.4 years) with normal ECG; Group A (GA), 10 patients (6 women, 4 men, mean age 63.1 +/- 6.8 years) with ECG image of strain; Group B (GB) (9 women and 8 men, mean age 61.3 +/- 10.1 years) with other ST-T alterations. We assessed by echocardiographic and transmitral flow Doppler study left ventricular structure and (systolic and diastolic) function. RESULTS: Interventricular septum thickness, left ventricular posterior wall thickness, left ventricular mass and mass index were significantly higher in the GA and GB than in the CG, without differences between GA and GB groups. No differences in left ventricular systolic function parameters were observed between the groups. In comparison with the CG, the GA and GB showed significant differences in E wave deceleration velocity and deceleration time, A wave deceleration time and isovolumetric relaxation time. Between GA and GB differences were observed in A wave deceleration time and isovolumetric relaxation time. CONCLUSIONS: In hypertensive patients without atherosclerotic coronaropathy, ST-T changes identify a group with greater left ventricular mass and worse left ventricular diastolic function. The patients with a ST-T strain pattern showed the impaired diastolic function.

The influence of the design on the medium to long-term hemodynamic behavior of 19 mm pericardial aortic valve prostheses.

BACKGROUND AND AIMS OF THE STUDY: The hemodynamics of five designs of 19 mm pericardial aortic valve bioprosthesis were examined by Doppler echocardiography in 48 resting patients at medium or long term follow up. METHODS: The salient differences among the five designs are that valve leaflets are mounted inside the support frame in one (the Carpentier-Edwards valve, evaluated in five patients) and outside the frame in the other four (the Ionescu-Shiley (14 patients), Mitroflow (six patients), Bioflo (eight patients) and Labcor-Santiago (15 patients)); and that two models have either total (Bioflo) or partial (Labcor-Santiago) protective pericardial sheaths on the stent, while the other three do not. The hemodynamic parameters determined included transvalvular pressure drop, valve area, left ventricular outflow tract diameter, subvalvular/valvular velocity ratio and subvalvular/valvular velocity-time integral ratio. RESULTS: There were no significant differences among the various valves as regards left ventricular outflow tract diameter, subvalvular/valvular velocity ratio or subvalvular/valvular velocity-time integral ratio. Negative correlation between left ventricular outflow tract diameter and subvalvular velocity (r = -0.63, p < 0.001) confirmed the need to correct for prevalvular velocities when using the Bernoulli equation to calculate the pressure drop across small pericardial aortic valve bioprostheses. The Bioflo design caused significantly greater pressure drops (peak 49.6 +/- 11.3 mmHg, mean 28.1 +/- 6.1 mmHg) and provided smaller areas (0.80 +/- 0.16 cm2) than the Ionescu-Shiley (26.7 +/- 6.6 and 15.2 +/- 4.1 mmHg, 1.17 +/- 0.17 cm2) and Labcor-Santiago (24.8 +/- 5.9 and 15.1 +/- 3.7 mmHg, 1.24 +/- 0.12 cm2) valves. CONCLUSIONS: Of the currently available 19 mm bovine pericardium heart valve bioprostheses, the Mitroflow and Labcor-Santiago valves, in both of which the leaflets are mounted outside the stent, have better hemodynamics in the aortic position than the Carpentier-Edwards valve, which has internal leaflet mounting. Sheathing the stent totally in pericardium, as in the withdrawn Bioflo valve, gives rise to relatively poor hemodynamics.

Hemodynamics of various designs of 19 mm pericardial aortic valve bioprosthesis.

The hemodynamics of five designs of 19 mm pericardial aortic valve bioprostheses were examined in 47 resting patients by Doppler echocardiography. The salient differences among the five designs are that valve leaflets are mounted inside the support frame in one (the Carpentier-Edwards valve, evaluated in 4 patients) and outside the frame in the other four (the Ionescu-Shiley (16 patients), Mitroflow (4), Bioflo (8) and Labcor-Santiago (15)); and that two models have either total (Bioflo) or partial (Labcor-Santiago) protective pericardial sheaths on the stent, while the other three do not. The hemodynamic parameters determined included transvalvular pressure drop, valve area, left ventricular outflow tract diameter, subvalvular/valvular velocity ratio and subvalvular/valvular velocity-time integral ratio. There were no significant differences among the various valves as regards left ventricular outflow tract diameter, subvalvular/valvular velocity ratio or subvalvular/valvular velocity-time integral ratio. Negative correlation between left ventricular outflow tract diameter and subvalvular velocity (r = -0.66, P < 0.001) confirmed the need to correct for prevalvular velocities when using the Bernouilli equation to calculate the pressure drop across small pericardial aortic valve bioprostheses. The Bioflo design caused significantly greater pressure drops (peak 38.3 +/- 8.3 mmHg, mean 24.6 +/- 4.8 mmHg) and smaller areas (0.82 +/- 0.17 cm2) than the Ionescu-Shiley (20.3 +/- 5.6 and 11.7 +/- 3.8 mmHg, 1.19 +/- 5.3 and 10.1 +/- 3.1 mmHg, 1.27 +/- 0.12 cm2) valves.

Left ventricular systolic function after marked reduction of ventricular hypertrophy induced by 5 years' enalapril treatment.

OBJECTIVES: To determine the effects of long-term treatment of essential hypertension with an angiotensin-converting enzyme inhibitor as regards arterial pressure at rest and during exercise, left ventricular mass and functional sequelae. PATIENTS AND METHODS: Twenty-six patients with previously untreated essential hypertension took enalapril 20 mg twice daily for 5 years. Cardiovascular parameters were determined by two-dimensionally guided M-mode echocardiography in a pre-treatment placebo phase, 8 weeks and 1, 3 and 5 years after the start of therapy, and 8 weeks after drugs were discontinued. RESULTS: Therapy reduced resting arterial pressure from 156/105 to 128/84 mmHg (P < 0.001) and arterial pressure during exercise from 205/113 to 172/94 mmHg (P < 0.0011). After 1, 3 and 5 years' therapy, left ventricular mass index had decreased by 15, 28 and 39% respectively (P < 0.001 in each case). Eight weeks after treatment was halted, arterial pressure at rest and during exercise had returned to pre-treatment values, but decreased left ventricular mass was maintained. Left ventricular pump function had improved after 5 years' treatment, and this improvement was maintained during the 8 weeks without treatment. CONCLUSIONS: Significant reductions in arterial pressure at rest and during exercise were achieved by 8 weeks' treatment with enalapril and maintained during 5 years' further treatment, while a marked reduction in left ventricular mass took place progressively throughout the 5 year period. Reduction of myocardial hypertrophy by enalapril appeared to be beneficial rather than detrimental to cardiac pump performance.

[Electrocardiographic patterns in hypertensive patients without atherosclerotic coronary disease. Influence of the left ventricular mass]. / Patrones electrocardiográficos en hipertensos sin coronariopatía aterosclerosa. Influencia de la masa ventricular izquierda.

BACKGROUND: ECG ST-T segment abnormalities in hypertensive patients are traditionally associated with hypertrophy or ischaemia. Hypertensive patients with abnormalities in ST-T segment in DI, aVL and/or V5-V6 underwent an echocardiographic study in order to assess left ventricular structure. All of them, in addition to the electric changes, showed typical or non-typical thoracic discomfort, showing a normal coronariographic study. METHODS: Hypertensive patients with ST-T segment changes were classified as follows: group A, 12 patients (8 women, 4 men, mean age 63.6 +/- 7.2 years) with ECG image of left ventricular overload pattern; group B, 9 patients (3 men, 6 women, mean age 62.3 +/- 6.3 years) with flat ST segment depression; and group C, 10 patients (3 men, 7 women, mean age 62.4 +/- 9.7 years) without changes on the ST-T segment with flat or negative T wave. Control group is made up 12 hypertensive patients (7 women, 5 men, mean age 61.6 +/- 7.6 years) with normal ECG. We assess by echocardiography interventricular septal thickness (IVST) and left ventricular posterior wall thickness (PWT) in mm, left ventricular end-diastolic diameter (DTD) in mm, left ventricular mass (LVM) in grs, and the mass index (MI) in g/m2. RESULTS: IVST, PWT, LVM and MI were significantly (p < 0.05) higher in the groups A, B and C than in the control group. No statistically significant differences were observed between the A, B and C groups. Stepwise discriminant analysis showed that the only parameter with independent value for discriminating between control, group and group ABC (the union of groups A, B and C) was IVST. CONCLUSION: In hypertensive patients without coronariopathy, ST-T changes identify a group with greater left ventricular mass. The different electrocardiographic patterns considered were not associated with a significantly different left ventricular mass.

[Activity of leukocyte elastase in coronary disease diagnosed by coronarography]. / Actividad de la elastasa leucocitaria en la enfermedad arterial coronaria determinada por coronariografía.

OBJECTIVE: To evaluate the clinical usefulness of leukocyte elastase concentration for diagnosis of coronary artery disease. BACKGROUND: Recent research has shown the important role elastase, a proteolytic enzyme released by neutrophils, in the pathogenesis of coronary atherosclerotic disease. METHODS: 95 patients underwent coronary angiography during investigation of chest pain and/or heart valve disease; 38 had normal coronary arteriograms (Group I) and 57 had coronary lesions (Group II). The patients were characterized as regards presence or absence of stable or unstable angina, family history of coronary artery disease, smoking, diabetes mellitus, hypertension, leukocyte counts, plasma lipid and elastase concentrations. Among Group II patients, those with simple atheromatous plaques were distinguished from those with complex plaques. RESULTS: Elastase concentrations were greater in the Group II than in the Group I (41 +/- 21 vs 27 +/- 14 micrograms/L) (p < 0.001), and greater among complex plaque patients than among simple plaque patients (53 +/- 27 vs 33 +/- 12 micrograms/L) (p < 0.001). Logistic regression analysis showed than elastase concentration, angina, age and sex had independent value for prediction of coronary artery disease and that the risk increased by 7% for every 1 microgram/L increase in elastase concentration. Among Group II patients, the risk of complex plaque was greatest for those with unstable angina and high elastase concentration, increasing by 6% for every 1 microgram/L increase in elastase concentration. CONCLUSIONS: Peripheral blood leukocyte elastase concentration is a sensitive diagnostic marker of coronary artery disease. High values suggest the presence of complex atheromatous plaques.

[Effect of verapamil and nitrendipine on the left ventricular mass and function (systolic and diastolic) in arterial hypertension]. / Efecto de verapamilo y nitrendipino sobre la masa y función (sistólica y diasólica) ventricular izquierda en la hipertensión arterial.

BACKGROUND: To evaluate the effect of two calcium antagonists (verapamil and nitrendipine) on the regression of left ventricular mass and function (systolic and diastolic) by echocardiography-Doppler, in not treated hypertensive subjects. METHODS: 31 hypertensive subjects were studied in a randomized, placebo controlled, prospective and double blind trial. Verapamil (120-240 mg/day) was administered in 16 and nitrendipine (10-20 mg/day) in 15. The active drug therapy phase was 12 months with rest and effort tensional evaluation. Echo-Doppler was performed in the placebo phase, 6 and 12 months, evaluating left ventricular structure (septal and posterior-wall thicknesses, diameters and mass) and function (systolic and diastolic). RESULTS: Tensional control at rest and under effort was similar with both drugs, heart rate decreased only with verapamil. Left ventricular mass index decreased with verapamil and nitrendipine, due to reduction in the wall thicknesses (with verapamil from 158.5 +/- 31 to 135.7 +/- 20 g/m2 and with nitrendipine from 167.3 +/- 26 to 146.9 +/- 21 g/m2, p < 0.05). Left ventricular systolic function was not modified during the follow-up with both drugs. Only in the verapamil group some left ventricular diastolic function parameters improved (E from 0.82 +/- 0.11 to 0.95 +/- 0.14 and E/A/Age from 0.013 +/- 0.005 to 0.017 +/- 0.005; p < 0.05). CONCLUSIONS: Verapamil and nitrendipine exerts a similar tensional control at rest and under effort and left ventricular mass regression. The improvement of some diastolic function parameters in the verapamil group was probably due to bradycardia.

[Congenital anomalies of the origin of the coronary arteries. The diagnostic and therapeutic aspects]. / Anomalías congénitas del origen de las arterias coronarias. Aspectos diagnósticos y terapéuticos.

We report 5 cases of congenital coronary artery anomalies. Two involving the right coronary artery arise from the left sinus of Valsalva, two of the circumflex artery arise from the right sinus of Valsalva and a patient with the left coronary artery arise from the right coronary ostium and passes obliquely posteriorly behind the right ventricular outflow tract and the aorta suffering an acute myocardial infarction and coronary artery by-pass surgery was performed in the acute phase.

Leukocyte count as a predictor of the severity ischaemic heart disease as evaluated by coronary angiography.

Increased white blood cell count has been reported associated with increase risk of coronary heart disease. We studied the relationship of white blood cell count to the 5 year incidence of coronary heart disease mortality in 152 men, without myocardial infarction or infection in the 6 months prior to the study. The coronary heart disease was determined by coronary arteriography study in all patients. None was treated by revascularization procedures (surgical or percutaneous transluminal coronary angioplasty). The severity of coronary heart disease was assessed by Gensini's Score and number of main coronary arteries with significant stenosis. The white blood cell count showed a positive correlation with Gensini's Score (r = 0.45, p < 0.01), and was significantly higher in the patients with three vessels disease (one vessel = 7084 +/- 1679 leukocytes/mm3; two vessels = 7768 +/- 1860 leukocytes/mm3; three vessels = 8174 +/- 2016 leukocytes/mm3; p < 0.05). The patients who died differed significantly from the survivors as regards total leukocyte count (8309 +/- 2271 against 7548 +/- 1702 cells/mm3; p < 0.05). Multivariate analysis, using a stepwise logistic regression, identified the white blood cell count as the more strong independent predictive variable for Gensini's Score (r = 0.42, p < 0.001). We conclude that, in our experience, increased white blood cell count may contribute to the initiation and progression of the coronary heart disease, and was associated with a shorter subsequent survival time.

[Acute myocardial infarction in cocaine addicts]. / Infarto agudo de miocardio en adictos a la cocaína.

The cases of 4 young patients (3 males, 1 female) addicts to cocaine with acute myocardial infarction is reported. In the first case, in a 28 year-old woman was found a multisystemic disorder with anterolateral myocardial infarction, acute renal failure, rhabdomyolysis and death. In the necropsy examination no atherosclerotic coronary lesions were found. In other two cases, was carried out coronary angiography, who revealed in one case normal angiographically coronary arteries, and in the other case, a 80% coronary narrowing in the proximal segment of the infarct-related coronary artery. We reviewed the cocaine-induced heart disease, and the pathophysiology of the acute myocardial infarction related to cocaine use.

[Supravalvular aortic stenosis and coronary aneurysm]. / Estenosis aórtica supravalvular y aneurisma coronario.

A 32-year old woman, with endocarditis caused by Streptococcus mitis, and systolic murmur is presented. The Doppler examination was found a systolic gradient of 150 mmHg. Aortography showed a multiple membranous supravalvular aortic stenosis, with aneurysmal dilatation of the left main coronary artery and circumflex artery, associated with bicuspid aortic valve and mild aortic insufficiency. The patient died suddenly by cardiac arrest in stand by to cardiac surgery. Anatomic comprobation was not possible. The coronary artery anomalies associated with the supravalvular aortic stenosis syndrome are reviewed.

[Regression of left ventricular mass in arterial hypertension. Efficacy of 3 different treatment protocols]. / Regresión de la masa ventricular izquierda en la hipertensión arterial. Eficacia de tres diferentes pautas de tratamiento.

BACKGROUND: To evaluate the antihypertensive efficacy, at rest and under exercise, in patients treated with three different antihypertensive drugs and the modifications induced on the left ventricular mass. METHODS: Fifty hypertensive males, mean age 51 years, 15 received 50 mg/day of chlorthalidone, 20 atenolol (100 mg/day) and 15 enalapril (20-40 mg/day). Baseline pressure control and echocardiogram, and 3, 6 and 9 months after starting therapy were performed. Thickness of the interventricular septum and posterior left ventricular wall in mm, left ventricular mass index in g/m2 were determined. RESULTS: The baseline septum in the diuretic group was 15 +/- 3 mm and 14 +/- 3 mm at 9 months, in the atenolol group was 16 +/- 3 mm and 12 +/- 2 mm (p less than 0.001), and in the enalapril group 15 +/- 2 mm and 12 +/- 3 mm (p less than 0.01). The posterior wall was 14 +/- 3 mm and 13 +/- 2 mm in the diuretic group, in the atenolol group 15 +/- 2 mm and 12 +/- 2 mm (p less than 0.001) and in the enalapril group 15 +/- 2 mm and 12 +/- 3 mm (p less than 0.01). The left ventricular mass index was in he diuretic group 153 +/- 45 g/m2 and 146 +/- 36 g/m2, in the atenolol group 167 +/- 34 g/m2 and 128 +/- 24 g/m2 (p less than 0.001) and in the enalapril group 156 +/- 36 g/m2 and 131 +/- 26 g/m2 (p less than 0.05). CONCLUSIONS: The antihypertensive efficacy at rest was similar with the three drugs, being under exercise superior atenolol and enalapril. Only atenolol and enalapril induced regression of left ventricular mass.

[Clinical and prognostic implications of age in acute myocardial infarct]. / Implicaciones clínicas y pronósticas de la edad en el infarto agudo de miocardio.

The purpose of this study was to evaluate the clinical characteristics and the factors related to early mortality in the acute myocardial infarction of the geriatric population. We studied 814 consecutive patients with their first acute myocardial infarction admitted to the coronary care unit at tha Hospital General de Galicia. 401 patients were older than 65 years (Group A) and 413 were younger (Group B). Group A was found a significantly lower percentage of males (64.7% versus 88.4%; p less than 0.001) and smokers (46.7% versus 72.7%; p less than 0.001; and older patients showed a greater incidence of diabetes mellitus (28.1% versus 15.2%; p less than 0.001) and arterial hypertension (45.6% versus 31.7%; p less than 0.01). In the geriatric population, the clinical course of the acute myocardial infarction is characterized by a greater incidence of heart failure (35.3% versus 11.1%; p less than 0.001), cardiogenic shock (18% versus 5.7%; p less than 0.001) and post-acute myocardial infarction angina pectoris (18.3% versus 12.2%; p less than 0.05). Early mortality (first month) was significantly higher in elderly patients (22.7% versus 6.3%; p less than 0.001). The multivariate analysis by stepwise logistic regression identified cardiogenic shock, age and heart failure as the only independent predictive variables for early mortality. We conclude that early mortality in the acute myocardial infarction is high and related to severe degrees of pump failure and age.