Menon V, Hochman J S, Stebbins A, Pfisterer M, Col J, Anderson R D, Hasdai D, Holmes D R, Bates E R, Topol E J, Califf R M, Ohman E M
Division of Cardiology, St. Luke's-Roosevelt Hospital Center, Columbia University, New York, NY 10025, USA.
Eur Heart J. 2000 Dec;21(23):1928-36. doi: 10.1053/euhj.2000.2240.
We used the GUSTO-I and GUSTO-III databases to evaluate our performance in treating cardiogenic shock patients over much of the 1990s.
GUSTO-I (1990-1993) and GUSTO-III (1995-1997) prospectively identified all patients with cardiogenic shock complicating acute myocardial infarction. Demographics, clinical presentation and outcomes for cardiogenic shock patients in the two trials were compared. Only patients enrolled with cardiogenic shock in countries common to both trials were included in these analysis. The 695 patients with cardiogenic shock in GUSTO-III were compared with the 2814 patients with cardiogenic shock in GUSTO-I. GUSTO-III patients were older (P=0.0001) and more likely to be diabetic (P=0.009) and hypertensive (P=0.025). They had a higher Killip class (P=0.002) and significantly greater index anterior infarction than cardiogenic shock patients enrolled in GUSTO-I. Time to treatment, presentation heart rate, and diastolic blood pressure were similar; however, systolic blood pressure at presentation was higher among GUSTO-III patients (P=0.002). Rates of coronary angiography, pulmonary artery catheterization, and mechanical ventilation declined in GUSTO-III compared with GUSTO-I (P=0.001); rates of angioplasty and bypass surgery were similar. Cardiogenic shock mortality in GUSTO-III was significantly higher than in GUSTO-I (62 vs 54%, P=0.001), as were rates of reinfarction (14 vs 11%, P=0.013) and recurrent ischaemia (35 vs 27%, P=0.00001). Mortality at non-U.S. sites (68 and 64%) was higher than at U.S. sites (53 and 50%) in both GUSTO-I and GUSTO-III studies, respectively. Angioplasty, bypass surgery, and balloon pump rates were lower for non-U.S. patients.
Cardiogenic shock continues to be associated with high mortality in thrombolytic-treated patients. Lower mortality observed in the U.S.A. supports consideration for percutaneous and surgical revascularization.
我们使用GUSTO-I和GUSTO-III数据库评估了我们在20世纪90年代大部分时间里治疗心源性休克患者的表现。
GUSTO-I（1990 - 1993年）和GUSTO-III（1995 - 1997年）前瞻性地识别了所有并发急性心肌梗死的心源性休克患者。比较了两项试验中心源性休克患者的人口统计学、临床表现和结局。这些分析仅纳入了在两项试验共有的国家中登记有心源性休克的患者。将GUSTO-III中的695例心源性休克患者与GUSTO-I中的2814例心源性休克患者进行了比较。GUSTO-III患者年龄更大（P = 0.0001），更有可能患有糖尿病（P = 0.009）和高血压（P = 0.025）。他们的Killip分级更高（P = 0.002），与GUSTO-I登记的心源性休克患者相比，前壁梗死指数显著更大。治疗时间、就诊时心率和舒张压相似；然而，GUSTO-III患者就诊时的收缩压更高（P = 0.002）。与GUSTO-I相比，GUSTO-III中冠状动脉造影、肺动脉导管插入术和机械通气的比率下降（P = 0.001）；血管成形术和搭桥手术的比率相似。GUSTO-III中心源性休克死亡率显著高于GUSTO-I（62%对54%，P = 0.001），再梗死率（14%对11%，P = 0.013）和复发性缺血率（35%对27%，P = 0.00001）也是如此。在GUSTO-I和GUSTO-III研究中，非美国地区的死亡率（分别为68%和64%）高于美国地区（分别为53%和50%）。非美国患者的血管成形术、搭桥手术和球囊泵使用率较低。
在心源性休克患者接受溶栓治疗时，死亡率仍然很高。在美国观察到的较低死亡率支持考虑进行经皮和外科血管重建术。
