Zahger Doron, Maimon Nimrod, Novack Victor, Wolak Arik, Friger Michael, Gilutz Harel, Ilia Reuben, Almog Yaniv
Department of Cardiology, Soroka University Medical Center, Beer Sheva, Israel.
Am J Cardiol. 2005 Dec 15;96(12):1644-8. doi: 10.1016/j.amjcard.2005.07.086. Epub 2005 Oct 21.
Patients with acute coronary syndromes (ACSs) may develop serious multiorgan complications and require prolonged intensive care. Our aim was to characterize and identify factors that are associated with outcomes in these patients. We retrospectively identified 267 consecutive patients admitted to the coronary care unit for an ACS who required >3 days of mechanical ventilation. Multiple clinical and laboratory variables were correlated with mortality. Patients' ages were 68.3 +/- 10.9 years (mean +/- SD) and 165 (62%) were men. Seventy-six patients (29%) died within 30 days of admission, and the 1 year mortality was 46%. Moderate or severe left ventricular systolic dysfunction was found in 72% of the patients. Eighty-nine patients (33.3%) required vasopressors, of whom 64 (72%) did not survive 30 days. Among 127 patients who required antibiotics (48.3%), 30-day mortality was 53% compared with 4% among patients who did not require antibiotics (p <0.001). The 30-day mortality among patients who received both antibiotics and vasopressors was 64 of 87 patients (74%), and the 1-year mortality in this subgroup was 86.2%. Parameters found to be independent predictors of 30-day mortality were (in descending order): vasopressor requirement, use of antibiotics, peripheral vascular disease, ST-elevation myocardial infarction, renal failure, obesity and Killip class on admission. In conclusion, mortality among patients who require prolonged mechanical ventilation after an ACS is substantial. The main independent predictors of with mortality are the severity of heart failure and the presence of co-morbidities.
急性冠脉综合征（ACS）患者可能会出现严重的多器官并发症，需要长时间的重症监护。我们的目的是描述和确定与这些患者预后相关的因素。我们回顾性地确定了267例因ACS入住冠心病监护病房且需要机械通气超过3天的连续患者。多个临床和实验室变量与死亡率相关。患者年龄为68.3±10.9岁（均值±标准差），165例（62%）为男性。76例患者（29%）在入院后30天内死亡，1年死亡率为46%。72%的患者存在中度或重度左心室收缩功能障碍。89例患者（33.3%）需要血管升压药，其中64例（72%）未能存活30天。在127例需要使用抗生素的患者中（48.3%），30天死亡率为53%，而不需要使用抗生素的患者中这一比例为4%（p<0.001）。同时接受抗生素和血管升压药治疗的患者中，87例患者中有64例（74%）的30天死亡率，该亚组的1年死亡率为86.2%。被发现是30天死亡率独立预测因素的参数（按降序排列）为：血管升压药需求、抗生素使用、外周血管疾病、ST段抬高型心肌梗死、肾衰竭、肥胖和入院时的Killip分级。总之，ACS后需要长时间机械通气的患者死亡率很高。死亡率的主要独立预测因素是心力衰竭的严重程度和合并症的存在。
