[Elective primary angioplasty in cardiogenic shock: results from a single center]. / Angioplastia primaria electiva en el shock cardiogénico: resultados de un estudio unicéntrico.

INTRODUCTION: Cardiogenic shock is the leading cause of death among patients hospitalized for acute myocardial infarction. Conventional treatment for acute myocardial infarction does not achieve a better outcome in these patients, but prior studies with emergency revascularization by coronary angioplasty seem to provide encouraging results. PATIENTS AND METHOD: A retrospective study of the clinical and angiographic results of elective primary angioplasty in 48 patients with cardiogenic shock complicating acute myocardial infarction of less than 12 hours is described. Intraaortic balloon counterpulsation was used in 79% of the patients. Patients with cardiogenic shock secondary to mechanical complications were excluded. RESULTS: Angiographic success, defined as a residual stenosis < 50% and final TIMI flow >/= 2, was achieved in 85% of the culprit lesions, and stents were implanted in 76%. Multivessel angioplasty was performed in 25% of the patients, and abciximab was used in 35% of the cases. Mean time from the onset of symptoms to angioplasty was 7.4 +/- 3.1 hours. In-hospital survival was 58%, and was 54% at six months follow-up. CONCLUSIONS: Emergency coronary revascularization with primary angioplasty and intracoronary stenting is effective in patients with acute myocardial infarction and cardiogenic shock. TIMI flow >/= 2 is achieved in most patients, and mortality is reduced when compared with conservative treatment in historical series.

[Demonstrated myocardial ischemia due to multiple coronary fistulae draining into the left ventricle]. / Isquemia miocárdica demostrada secundaria a fístulas coronarias múltiples con drenaje en el ventrículo izquierdo.

There are few cases of demonstrated ischemia due to the presence of multiple coronary fistulae. We report a case of multiple coronary fistulae from left anterior descending, circumflex and right coronary arteries draining into the left ventricle, which were responsible for myocardial ischemia demonstrated with thallium stress test. They were diagnosed by coronary angiography, and their etiology seems to be congenital. The final control of symptoms was achieved with beta-blockers, and not with nitrates, which speaks for a steal phenomenon as the cause of ischemia.