Brodie Bruce R, Stuckey Thomas D, Hansen Charles, Bradshaw Barbara H, Downey William E, Pulsipher Mark W
LeBauer Cardiovascular Research Foundation and Moses Cone Heart and Vascular Center, Greensboro, North Carolina, USA.
Am J Cardiol. 2007 Feb 15;99(4):431-5. doi: 10.1016/j.amjcard.2006.09.091. Epub 2006 Dec 20.
This study compared late survival after primary percutaneous coronary intervention (PCI) in patients with cardiogenic shock due to right ventricular (RV) infarction versus left ventricular (LV) pump failure. Consecutive patients with ST-elevation myocardial infarction treated with primary PCI (n = 2,496) were prospectively enrolled in a registry from 1984 to 2004. Cardiogenic shock occurred before PCI in 189 patients (7.6%). Shock was attributed to predominant RV infarction when there was right coronary artery occlusion with preserved LV function and increased right atrial pressure. Patients with shock due to RV infarction (n = 30) versus LV pump failure (n = 136) had fewer previous infarctions (10% vs 29%, p = 0.03), less multivessel disease (20% vs 47%, p = 0.007), higher right atrial pressure (21 vs 16 mm, p = 0.003), and better LV ejection fraction (57% vs 32%, p <0.001). In-hospital mortality was lower with shock due to RV infarction (23% vs 50%, p = 0.01), and shock due to RV infarction was a significant independent predictor of late cardiac survival (hazard ratio 0.28, 95% confidence interval 0.13 to 0.62, p = 0.002). In conclusion, survival after primary PCI in patients with shock due to RV infarction is better than that in patients with shock due to LV pump failure. This is in contrast to most previous reports. Improved survival is likely related to lower risk profile and previously documented substantial recovery of RV function after primary PCI.
本研究比较了因右心室（RV）梗死与左心室（LV）泵衰竭导致的心源性休克患者在接受直接经皮冠状动脉介入治疗（PCI）后的远期生存率。1984年至2004年期间，连续入选了2496例接受直接PCI治疗的ST段抬高型心肌梗死患者，并将其纳入一项登记研究。189例患者（7.6%）在PCI术前发生心源性休克。当右冠状动脉闭塞但左心室功能保留且右心房压力升高时，休克被归因于主要的右心室梗死。因右心室梗死导致休克的患者（n = 30）与因左心室泵衰竭导致休克的患者（n = 136）相比，既往梗死次数较少（10%对29%，p = 0.03），多支血管病变较少（20%对47%，p = 0.007），右心房压力较高（21对16 mmHg，p = 0.003），左心室射血分数较好（57%对32%，p <0.001）。因右心室梗死导致休克的患者住院死亡率较低（23%对50%，p = 0.01），且右心室梗死导致的休克是远期心脏生存的显著独立预测因素（风险比0.28，95%置信区间0.13至0.62，p = 0.002）。总之，因右心室梗死导致休克的患者在接受直接PCI后的生存率高于因左心室泵衰竭导致休克的患者。这与大多数既往报道相反。生存率的提高可能与较低的风险特征以及既往记录的直接PCI后右心室功能的显著恢复有关。
