Wong S C, Sanborn T, Sleeper L A, Webb J G, Pilchik R, Hart D, Mejnartowicz S, Antonelli T A, Lange R, French J K, Bergman G, LeJemtel T, Hochman J S
Department of Internal Medicine, the New York Hospital-Cornell Medical Center, New York, USA.
J Am Coll Cardiol. 2000 Sep;36(3 Suppl A):1077-83. doi: 10.1016/s0735-1097(00)00873-1.
We sought to delineate the angiographic findings, clinical correlates and in-hospital outcomes in patients with cardiogenic shock (CS) complicating acute myocardial infarction.
Patients with CS complicating acute myocardial infarction carry a grave prognosis. Detailed angiographic findings in a large, prospectively identified cohort of patients with CS are currently lacking.
We compared the clinical characteristics, angiographic findings, and in-hospital outcomes of 717 patients selected to undergo angiography and 442 not selected, overall and by shock etiology: left or right ventricular failure versus mechanical complications.
Patients who underwent angiography had lower baseline risk and a better hemodynamic profile than those who did not. Overall, 15.5% of the patients had significant left main lesions on angiography, and 53.4% had three-vessel disease, with higher rates of both for those with ventricular failure, compared with patients who had mechanical complications. Among patients who underwent angiography, those with ventricular failure had significantly lower in-hospital mortality than patients with mechanical complications (45.2% vs. 57.0%; p = 0.021). Importantly, for patients with ventricular failure, in-hospital mortality also correlated with disease severity: 35.0% for no or single-vessel disease versus 50.8% for three-vessel disease. Furthermore, mortality was associated with the culprit lesion location (78.6% in left main lesion, 69.7% in saphenous vein graft lesions, 42.4% in circumflex lesions, 42.3% in left anterior descending lesions, and 37.4% in right coronary artery lesions), and Thrombolysis In Myocardial Infarction (TIMI) flow grade (46.5% in TIMI 0/1, 49.4% in TIMI 2 and 26% in TIMI 3).
Patients who underwent angiographic study in the SHOCK Trial Registry had a more benign cardiac risk profile, more favorable hemodynamic findings and lower in-hospital mortality than those for whom angiograms were not obtained. Patients with CS caused by ventricular failure had more severe atherosclerosis, and a different distribution of culprit vessel involvement but lower in-hospital mortality, than those with mechanical complications. Overall in-hospital survival correlates with the extent of coronary artery obstructions, location of culprit lesion and baseline coronary TIMI flow grade.
我们试图描绘并发急性心肌梗死的心源性休克（CS）患者的血管造影结果、临床相关性及住院结局。
并发急性心肌梗死的CS患者预后严重。目前缺乏对大量前瞻性确定的CS患者队列进行详细血管造影结果的研究。
我们比较了717例被选进行血管造影的患者和442例未被选进行血管造影的患者的临床特征、血管造影结果及住院结局，总体及按休克病因进行比较：左心室或右心室衰竭与机械并发症。
接受血管造影的患者基线风险较低，血流动力学情况优于未接受血管造影的患者。总体而言，15.5%的患者血管造影显示有严重左主干病变，53.4%的患者有三支血管病变，与有机械并发症的患者相比，心室衰竭患者这两种病变的发生率更高。在接受血管造影的患者中，心室衰竭患者的住院死亡率显著低于有机械并发症的患者（45.2%对57.0%；p = 0.021）。重要的是，对于心室衰竭患者，住院死亡率也与疾病严重程度相关：无或单支血管病变患者为35.0%，三支血管病变患者为50.8%。此外，死亡率与罪犯病变位置相关（左主干病变为78.6%，大隐静脉桥血管病变为69.7%，回旋支病变为42.4%，左前降支病变为42.3%，右冠状动脉病变为37.4%），以及心肌梗死溶栓（TIMI）血流分级相关（TIMI 0/1为46.5%，TIMI 2为49.4%，TIMI 3为26%）。
与未进行血管造影的患者相比，休克试验注册研究中接受血管造影检查的患者心脏风险状况更良性，血流动力学结果更有利，住院死亡率更低。由心室衰竭导致CS的患者比有机械并发症的患者动脉粥样硬化更严重，罪犯血管受累分布不同，但住院死亡率更低。总体住院生存率与冠状动脉阻塞程度、罪犯病变位置及基线冠状动脉TIMI血流分级相关。
