Samadi A, Le Feuvre C, Allali Y, Collet J-P, Barthélémy O, Beygui F, Helft G, Montalescot G, Metzger J-P
Institut de cardiologie, Département de cardiologie médicale, Groupe hospitalier Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, Paris cedex 13.
Arch Cardiovasc Dis. 2008 Mar;101(3):175-80. doi: 10.1016/s1875-2136(08)71800-x.
To assess mortality in people > or =75 years of age 6 months after myocardial infarction complicated by cardiogenic shock and treated by angioplasty with complete revascularisation and optimal anti-thrombotic treatment; to compare results to those of younger patients with or without shock and to analyse predictive factors for death.
The study is based on 1011 consecutive patients with myocardial infarction admitted for primary angioplasty, subdivided into four groups by age and the presence or absence of cardiogenic shock: group 1 (<75 years of age without shock, n=733), group 2 (<75 years of age with shock, n=49), group 3 (> or =75 years of age without shock, n=208) and group 4 (> or =75 years of age with shock, n=20). These four patient groups were compared for mortality rates and predictive factors for in-hospital and 6 month mortality.
In-hospital mortality in groups 1 to 4 was 1.7%, 30.6%, 9.1%, and 70% (p<0.0001) respectively and 6-month mortality was 3.1%, 40%, 16% and 78% (P<0.0001). By univariate analysis renal failure was a predictive factor for death at 6 months in patients without cardiogenic shock (groups 1 and 3), and left ventricular function in patients in group 2. No predictive factors were found in group 4 patients. The independent predictive factors for death at 6 months were: age >75 years of age (P<0.0003), cardiogenic shock (P<0.0001), triple vessel lesions (P<0.01) and creatinine clearance (P=0.004).
Mortality after angioplasty remains high in people > or =75 years with cardiogenic shock despite all the advances in the management of myocardial infarction. These disappointing results should encourage us to assess the role of surgical revascularisation and circulatory assistance.
评估年龄≥75岁、心肌梗死并发心源性休克且接受血管成形术实现完全血运重建及最佳抗栓治疗6个月后的死亡率；将结果与有或无心源性休克的年轻患者的结果进行比较，并分析死亡的预测因素。
本研究基于1011例因初次血管成形术入院的连续心肌梗死患者，根据年龄及有无心源性休克分为四组：第1组（年龄<75岁且无心源性休克，n = 733），第2组（年龄<75岁且有心源性休克，n = 49），第3组（年龄≥75岁且无心源性休克，n = 208）和第4组（年龄≥75岁且有心源性休克，n = 20）。比较这四组患者的死亡率以及住院和6个月死亡率的预测因素。
第1至4组的住院死亡率分别为1.7%、30.6%、9.1%和70%（p<0.0001），6个月死亡率分别为3.1%、40%、16%和78%（P<0.0001）。单因素分析显示，肾衰竭是无心源性休克患者（第1组和第3组）6个月死亡的预测因素，而左心室功能是第2组患者死亡的预测因素。在第4组患者中未发现预测因素。6个月死亡的独立预测因素为：年龄>75岁（P<0.0003）、心源性休克（P<0.0001）、三支血管病变（P<0.01）和肌酐清除率（P = 0.004）。
尽管心肌梗死治疗取得了诸多进展，但年龄≥75岁且有心源性休克患者血管成形术后的死亡率仍然很高。这些令人失望的结果应促使我们评估外科血运重建和循环辅助的作用。
