Many patients with cardiogenic shock after heart attack miss out on early revascularisation

The American College of Cardiology and the American Heart Association both recommend early mechanical revascularisation (usually percutaneous) for people aged less than 75 who develop cardiogenic shock after a heart attack. But about half of eligible patients in the United States were still missing out five years after the recommendations were published. A study based on data from a national register of patients with heart attack shows that in 2004, only 54.4% of patients with heart attack and cardiogenic shock had a percutaneous coronary intervention, although a further 3.2% had an immediate coronary artery bypass operation.

The National Registry of Myocardial Infarction, which is sponsored by the drugs industry, includes 293 633 US patients who had a heart attack with ST segment elevation between 1995 and 2004 and who presented to a hospital with revascularisation capability. Of these patients, 8.6% (25 311) had cardiogenic shock or developed it during their admission. Although their chances of percutaneous revascularisation have increased steadily from the 27.4% recorded in 1995, the recommendations had no measurable impact on the upward trend when they were published in 1999.

Although these high risk patients are less likely to die of cardiogenic shock now than they were 10 years ago (47.9% v 60.3%), these data show there is still plenty of room for improvement. In this study, as in others, better survival was clearly and independently associated with early revascularisation.

Pesticide poisoning still a problem in US schools

Between 1998 and 2002, 2593 children and adults become ill after exposure to pesticides in and around US schools. That's an incidence of 7.4 per million schoolchildren and 27.3 per million adult employees. Most of the illnesses were mild (2315, 89%), but 275 people (11%) were ill enough to need treatment, and in three people (0.1%) the illness was life threatening. Two thirds of the reported …