急性心肌梗死并发心源性休克患者一年生存率的相关因素：SHOCK试验的血管造影结果
Correlates of one-year survival inpatients with cardiogenic shock complicating acute myocardial infarction: angiographic findings from the SHOCK trial.
作者信息
Sanborn Timothy A, Sleeper Lynn A, Webb John G, French John K, Bergman Geoffrey, Parikh Manish, Wong S Chiu, Boland Jean, Pfisterer Matthias, Slater James N, Sharma Samin, Hochman Judith S
机构信息
Evanston Northwestern Healthcare, Evanston, Illinois 60201, USA.
出版信息
J Am Coll Cardiol. 2003 Oct 15;42(8):1373-9. doi: 10.1016/s0735-1097(03)01051-9.
OBJECTIVES
The goal of this study was to describe the core laboratory angiographic findings of "SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK" (SHOCK) trial participants and to determine the relationship of angiographic parameters to one-year survival.
BACKGROUND
In the SHOCK trial, emergency revascularization improved one-year survival of patients with cardiogenic shock compared with initial medical stabilization including thrombolysis and intraaortic balloon counterpulsation.
METHODS
Coronary angiography was performed by protocol in 147 of 152 (97%) patients in the emergency revascularization (ERV) group and by clinical selection in 100 of 150 (67%) patients in the initial medical stabilization (IMS) group. Of the other 50 IMS patients, 45 of 50 (90%) died rapidly and did not undergo angiography.
RESULTS
Left ventricular ejection fraction was correlated with one-year survival in both treatment groups (p < 0.001). In the IMS group, the hazard ratio for death was 2.59 (95% confidence interval 1.47 to 4.58, p = 0.001) per diseased vessel (0/1 vs. 2 vs. 3). In the ERV group, the hazard ratio for death per diseased vessel was 1.11 (95% confidence interval 0.79 to 1.56, p = 0.559). Multivariate analysis of the angiography cohort (without regard for left ventriculogram measurements) identified initial Thrombolysis in Myocardial Infarction flow grade (p = 0.032), number of diseased vessels (for IMS patients only, p = 0.024), and culprit vessel (p = 0.004) as independent correlates of one-year survival, even after adjustment for key clinical factors. In the smaller cohort with left ventricular ejection fraction measured (n = 97), ejection fraction and culprit vessel remained independently correlated with survival.
CONCLUSIONS
For patients in cardiogenic shock, left ventricular function and culprit vessel were independent correlates of one-year survival.
目的
本研究的目的是描述“我们是否应该对心源性休克患者的闭塞冠状动脉进行紧急血管重建”（SHOCK）试验参与者的核心实验室血管造影结果，并确定血管造影参数与一年生存率之间的关系。
背景
在SHOCK试验中，与包括溶栓和主动脉内球囊反搏在内的初始药物稳定治疗相比，紧急血管重建改善了心源性休克患者的一年生存率。
方法
紧急血管重建（ERV）组152例患者中的147例（97%）按照方案进行了冠状动脉造影，初始药物稳定治疗（IMS）组150例患者中的100例（67%）根据临床选择进行了冠状动脉造影。在其他50例IMS患者中，50例中的45例（90%）迅速死亡，未进行血管造影。
结果
两个治疗组的左心室射血分数均与一年生存率相关（p<0.001）。在IMS组中，每病变血管（0/1与2与3）的死亡风险比为2.59（95%置信区间1.47至4.58，p=0.001）。在ERV组中，每病变血管的死亡风险比为1.11（95%置信区间0.79至1.56，p=0.559）。血管造影队列的多变量分析（不考虑左心室造影测量）确定，即使在调整关键临床因素后，初始心肌梗死溶栓血流分级（p=0.032）、病变血管数量（仅针对IMS患者，p=0.024）和罪犯血管（p=0.004）是一年生存率的独立相关因素。在测量了左心室射血分数的较小队列（n=97）中，射血分数和罪犯血管仍然与生存率独立相关。
结论
对于心源性休克患者，左心室功能和罪犯血管是一年生存率的独立相关因素。
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