Palmeri Sebastian T, Lowe April M, Sleeper Lynn A, Saucedo Jorge F, Desvigne-Nickens Patrice, Hochman Judith S
UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Am J Cardiol. 2005 Oct 15;96(8):1042-9. doi: 10.1016/j.amjcard.2005.06.033. Epub 2005 Aug 22.
We investigated the association between race/ethnicity on the use of cardiac resources in patients who have acute myocardial infarction that is complicated by cardiogenic shock. The Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial examined the effect of reperfusion and revascularization treatment strategies on mortality. Patients screened but not enrolled in the SHOCK Trial (n = 1,189) were entered into the SHOCK registry. Of the patients in the United States registry (n = 538) who had shock due to predominant left ventricular failure, 440 were characterized as white (82%), 42 as Hispanic (8%), 34 as African-American (6%), and 22 as Asian/other (4%). The use of invasive procedures differed significantly by race/ethnicity. Hispanic patients underwent coronary angiography significantly less often than did white patients (38 vs 66%, p = 0.002). Among those patients who underwent coronary angiography, there were no race/ethnicity differences in the proportion of patients who underwent revascularization (p = 0.353). Overall in-hospital mortality (57%) differed significantly by race/ethnicity (p = 0.05), with the highest mortality rate in Hispanic patients (74% vs 65% for African-Americans, 56% for whites, and 41% for Asian/other). After adjustment for patient characteristics and use of revascularization, there were no mortality differences by race/ethnicity (p = 0.262), with all race/ethnicity subgroups benefiting equally by revascularization. In conclusion, the SHOCK registry showed significant differences in the treatment and in-hospital mortality of Hispanic patients who had cardiogenic shock, with these patients being less likely to undergo percutaneous coronary intervention. Therefore, early revascularization should be strongly considered for all patients, independent of race/ethnicity, who develop cardiogenic shock after acute myocardial infarction.
我们研究了种族/民族与急性心肌梗死并发心源性休克患者心脏资源使用之间的关联。“心源性休克时我们是否应紧急对闭塞冠状动脉进行血运重建”（SHOCK）试验考察了再灌注和血运重建治疗策略对死亡率的影响。筛选后未纳入SHOCK试验的患者（n = 1189）进入了SHOCK注册登记。在美国注册登记的因主要为左心室衰竭导致休克的患者（n = 538）中，440例为白人（82%），42例为西班牙裔（8%），34例为非裔美国人（6%），22例为亚裔/其他（4%）。侵入性操作的使用在种族/民族方面存在显著差异。西班牙裔患者接受冠状动脉造影的频率显著低于白人患者（38%对66%，p = 0.002）。在接受冠状动脉造影的患者中，接受血运重建的患者比例在种族/民族方面无差异（p = 0.353）。总体住院死亡率（57%）在种族/民族方面存在显著差异（p = 0.05），西班牙裔患者死亡率最高（74%，非裔美国人为65%，白人为56%，亚裔/其他为41%）。在对患者特征和血运重建的使用进行调整后，种族/民族之间不存在死亡率差异（p = 0.2:62），所有种族/民族亚组通过血运重建均同等受益。总之，SHOCK注册登记显示，患有心源性休克的西班牙裔患者在治疗和住院死亡率方面存在显著差异，这些患者接受经皮冠状动脉介入治疗的可能性较小。因此，对于所有在急性心肌梗死后发生心源性休克的患者，无论种族/民族如何，都应强烈考虑早期血运重建。
