Jakob Schneider | PubMed Health

PubMed2003

Abciximab-facilitated percutaneous coronary intervention and long-term survival--a prospective single-center registry.

AIMS: To identify predictors of use of abciximab and evaluate the long-term survival after percutaneous coronary intervention with or without abciximab in a broad spectrum of patients. METHODS: We prospectively evaluated, in a dedicated registry, the 4-year survival of patients undergoing percutaneous revascularization and the treatment with or without abciximab, using the Social Security Death Index. RESULTS: Among 10,471 patients treated between 2/1/1995 and 12/31/2001, 5655 received abciximab and 4816 did not. Propensity score analysis (c-statistic 0.83) identified the following variables to be independently associated with abciximab use: later date of procedure, stent use, acute or recent infarction, increasing lesion complexity, vein graft intervention, hyperlipidemia, normal renal function, male gender and decreasing age. Procedural success was higher in the abciximab group, 93 vs. 89%, P<0.001. Unadjusted Kaplan-Meyer survival analysis demonstrated a strong trend for improved survival in the abciximab group at 4 years, 86.3 vs. 84.7%, P=0.09. In the 7533 patients with acute coronary syndromes (ACS), the respective values were 86.0 vs. 83.6%, P=0.03. Multivariate Cox proportional hazard analysis identified increasing age, significant left ventricular dysfunction or congestive heart failure, chronic renal insufficiency and diabetes mellitus as main predictors of mortality. Abciximab was independently associated with improved survival only in patients with ACS (adjusted HR 0.87, 95% confidence interval, 0.81-1.00, P=0.05). Abciximab use was associated with a higher rate of access site hematoma (2.8 vs. 1.5%) and blood product transfusion (6.8% vs. 4.8%), P<0.001 for both. CONCLUSION: Abciximab use improves procedural success and is associated with lower 4-year mortality in patients with ACS, for whom it should be strongly considered. A lesser effect is seen in patients without high-risk characteristics.

Abciximab↗

PubMed2003

Septic shock.

Septic shock remains an important cause of death and serious morbidity in medical, surgical and obstetric illness. Many patients with septic shock succumb despite aggressive therapy. Any microorganism can initiate septic shock; the pathophysiology of the disease is not clear; the clinical manifestation is not specific; and there is no reliable laboratory result to diagnose septic shock before it is late. Moreover, despite increasingly complex modes of mechanical ventilation, sophisticated respiratory and hemodynamic monitoring, and a continually expanding array of potent antibiotics, the overall mortality from septic shock remained constant. Better outcome is more likely when recognition is early and treatment is much more aggressive. Therefore, where there is suspicion of septic shock: commence fluid resuscitation, administer oxygen, take blood, urine, and other fluids for culture, commence intravenous broad-spectrum antibiotics, pass a urethral catheter, determine the cause of sepsis and remove if possible, consult for expert medical advice and possible patient transfer to intensive care units, and provide supportive care to involved organ systems.

Anti-Bacterial Agents↗