Karcz Maciej, Bekta Paweł, Kepka Cezary, Witkowski Adam, Konopka Anna, Chmielak Zbigniew, Demkow Marcin, Debski Artur, Ciszewski Andrzej, Ciszewski Michał, Cedro Krzysztof, Skwarek Mirosław, Przyłuski Jakub, Kruk Mariusz, Kadziela Jacek, Deptuch Tomasz, Banaszewski Marek, Szajewski Tomasz, Stepińska Janina, Ruzyłło Witold
2nd Catheterisation Laboratory, National Institute of Cardiology, Warsaw, Poland.
Kardiol Pol. 2003 May;58(5):366-74; discussion: 374.
Mortality in acute myocardial infarction (MI) complicated by cardiogenic shock approaches 90%, regardless of the type of pharmacological treatment.
To assess in-hospital and mid-term results of invasive treatment of patients with acute MI with ST segment elevation (STEMI) complicated by cardiogenic shock.
From a prospective registry of all patients admitted to our institution for urgent coronary angiography due to acute coronary syndrome between February 2001 and June 2002, patients with STEMI, symptom duration up to 12 hours and cardiogenic shock diagnosed on admission were identified. The in-hospital and mid-term outcome of 37 patients (mean age 65 years, range 54-77, 68% of males) treated with primary percutaneous coronary intervention (PCI) was analysed.
Of the 41 patients with STEMI and cardiogenic shock, total occlusion or critical stenosis of a coronary artery were found in 38 patients. One patient with the occlusion of three main coronary arteries underwent urgent surgical revascularisation and remains alive after an 18-month follow-up. In the remaining 37 patients primary PCI of an infarct-related artery was performed (stent implantation in 70%, abciximab administration in 54%) which restored normal blood flow (TIMI grade 3 flow) in 54% of subjects. In patients with TIMI grade 3 flow the in-hospital mortality was 25%. Of the whole PCI-treated group, 18 (48.6%) patients died during stay in our institution, an additional two - after transfer to another hospital, and one - during a 19-month follow-up period. The remaining 16 patients remain alive (median follow-up of 8 months).
Invasive treatment of patients with STEMI complicated by cardiogenic shock significantly reduces mortality in this high-risk population. The mid-term results in patients discharged from hospital are good. Invasive treatment of acute MI should be accessible for all patients with extensive acute MI.
急性心肌梗死（MI）并发心源性休克时，无论采用何种药物治疗，死亡率都接近90%。
评估急性ST段抬高型心肌梗死（STEMI）并发心源性休克患者的侵入性治疗的院内及中期结果。
从2001年2月至2002年6月因急性冠状动脉综合征入住我院接受紧急冠状动脉造影的所有患者的前瞻性登记中，确定STEMI患者，症状持续时间达12小时且入院时诊断为心源性休克。分析了37例接受直接经皮冠状动脉介入治疗（PCI）的患者（平均年龄65岁，范围54 - 77岁，68%为男性）的院内及中期结局。
在41例STEMI并发心源性休克患者中，38例发现冠状动脉完全闭塞或严重狭窄。1例三支主要冠状动脉闭塞的患者接受了紧急外科血管重建术，在18个月的随访后仍存活。其余37例患者对梗死相关动脉进行了直接PCI（70%植入支架，54%给予阿昔单抗），其中54%的患者恢复了正常血流（TIMI 3级血流）。TIMI 3级血流患者的院内死亡率为25%。在整个PCI治疗组中，18例（48.6%）患者在我院住院期间死亡，另外2例在转至另一家医院后死亡，1例在19个月的随访期内死亡。其余16例患者存活（中位随访8个月）。
STEMI并发心源性休克患者的侵入性治疗显著降低了这一高危人群的死亡率。出院患者的中期结果良好。所有广泛急性MI患者都应能够接受急性MI的侵入性治疗。
