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For the week ending October 5, 2012
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Last week 374 articles were evaluated via DynaMed's Systematic Literature Surveillance and 227 were added to DynaMed content.
Based on the editors' criteria of selecting "articles most likely to change clinical practice," one article of significant interest was selected for the DynaMed Weekly Update.
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| Feature Article | |
Intra-Aortic Balloon Pump Does Not Improve Outcomes in Patients with Acute Myocardial Infarction and Cardiogenic Shock
Intra-aortic balloon pump (IABP) counterpulsation has become widely used for blood pressure support in the treatment of acute myocardial infarction (MI) complicated by cardiogenic shock. It is strongly recommended in these patients by guidelines from American College of Cardiology and American Heart Association (Circulation 2008 Jan 15;117(2):296) and from the European Society of Cardiology (Eur Heart J 2008 Dec;29(23):2909) despite a lack of high quality evidence supporting its use. A new report of a large randomized trial with 600 patients casts serious doubt on the efficacy of IABP in this scenario.
Patients with acute MI and cardiogenic shock (median age 70 years) who were expected to have a revascularization procedure were randomized to IABP vs. no IABP. In the IABP group, the balloon pump was inserted either before or immediately after the revascularization procedure, at the discretion of the investigator. The choice of revascularization procedure was at the discretion of the surgeon. Exclusion criteria included resuscitation for > 30 minutes, onset of shock > 12 hours before screening and mechanical cause of cardiogenic shock. Crossover to IABP treatment was allowed in the control group in cases of mechanical complications including ventricular septal defect or papillary muscle rupture, and occurred in about 10% of controls.
There were no significant differences in any clinical outcomes in the intention-to-treat analysis (level 1 [likely reliable] evidence). Comparing IABP vs. no IABP, 30-day mortality was 39.7% vs. 41.3%, major bleeding occurred in 3.3% vs. 4.4%, and reinfarction occurred in 3% vs. 1.4%. There were also no significant differences in the rates of peripheral ischemic complications, stroke, or sepsis. In the IABP group, 30-day mortality was 36.4% of 37 patients who received the pump before revascularization and 36.8% of 240 patients who received it after revascularization (not significant) (N Engl J Med 2012 Oct 4;367(14):1287).
For more information, see the Cardiogenic shock and ST-elevation myocardial infarction (STEMI) topics in DynaMed
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 Earn Credit for Reading this e-Newsletter
For more information on this educational activity, see the CME sidebar. | |
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American Academy of Family Physicians (AAFP) Scientific Assembly, October 17- 20, 2012
Senior Deputy Editor Dr. Alan Ehrlich will be attending the American Academy of Family Physicians Scientific Assembly 2012 at the Pennsylvania Convention Center in Philadelphia, Pennsylvania. Representatives will be available at the DynaMed booth to discuss peer review, mobile access, and free trial information.
Visit the American Academy of Family Physicians website to learn more about the event and for registration information.
American Academy of Pediatrics (AAP) National Conference & Exhibition, October 20-23, 2012
Deputy Editor Dr. Mike Woods will be attending the American Academy of Pediatrics National Conference & Exhibition at the Ernest N. Morial Convention Center in New Orleans, Louisiana. Representatives will be available at the DynaMed booth to discuss peer review, mobile access, and free trial information.
Visit the American Academy of Pediatrics website to learn more about the event and for registration information.
Medical Group Management Association (MGMA) Annual Conference, October 22-24, 2012
Deputy Editor Dr. Cynthia Brown will be attending the 2012 Medical Group Management Association Annual Conference at the Henry B. Gonzalez Convention Center in San Antonio, Texas. Representatives will be available at the DynaMed booth to discuss peer review, mobile access, and free trial information.
Visit the Medical Group Management Associationwebsite to learn more about the event and for registration information.
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CME Information
CREDITS
Physicians: 0.25 AMA PRA Category I Credit(s)™
Family Physicians: 0.25 Prescribed credits
Nurse Practitioners: 0.25 Contact hours
Release Date: October 10, 2012
Expiration Date: October 10, 2013
Estimated Completion Time:
15 minutes
There is no fee for this activity.
To Receive Credit
In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.
Program Overview
Learning Objectives
Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.
Faculty Information Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Senior Deputy Editor, DynaMed, Ipswich, Massachusetts, USA Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company
Disclosures
Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.
No commercial support has been received for this activity.
Accreditation Statements
ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
AAFP: Enduring Material activity, DynaMed Weekly Update, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 7, 2012. Term of approval is for one year from this date with the option of yearly renewal. Each Weekly Update is worth .25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners.
Program ID: 1102073F
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