Guo Liang, Mai Xiaoyan, Deng Jie, Liu Anheng, Bu Lun, Wang Haichang
Xijing Hospital, the Fourth Military Medical University, China.
Kardiol Pol. 2008 Jul;66(7):722-6; discussion 727-8.
The safety and effectiveness of emergency percutaneous coronary intervention (PCI) in elderly patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) are currently unknown.
To compare the outcome of elderly patients with AMI complicated by CS who were treated with primary PCI or thrombolysis.
Between 2001 and 2006 at Xijing Hospital we evaluated the outcome of 94 patients ł75 years old with AMI complicated by CS, of whom 33 underwent emergency PCI (PCI group), whereas the other 61 received initially conventional medication (CM group).
Baseline characteristics, infarct location, rate of intra-aortic balloon pump support and time from AMI onset to therapy were similar between the two groups. The success rate of revascularisation in the PCI group was 90.9% and the success rate of thrombolysis in the CM group was 60.7% (p=0.004). The PCI group had a lower in-hospital mortality than the CM group (42.4 vs. 65.6%, p=0.026). Kaplan-Meier curves showed a significant difference in survival (48.48 vs. 21.31%, p=0.006), favouring early PCI. Multiple logistic regression identified time from AMI onset to therapy as an independent predictor of in-hospital death (p=0.036). Cox regression analysis indicated early PCI as an independent factor to improve mid-term survival (p=0.015).
Emergency PCI improves 1-year survival compared with initial conventional medication for elderly patients with AMI complicated by CS.
目前尚不清楚急诊经皮冠状动脉介入治疗（PCI）在老年急性心肌梗死（AMI）合并心源性休克（CS）患者中的安全性和有效性。
比较接受直接PCI或溶栓治疗的老年AMI合并CS患者的治疗结果。
2001年至2006年期间，我们在西京医院评估了94例年龄≥75岁的AMI合并CS患者的治疗结果，其中33例接受了急诊PCI（PCI组），而另外61例最初接受了传统药物治疗（CM组）。
两组患者的基线特征、梗死部位、主动脉内球囊泵支持率以及从AMI发作到治疗的时间相似。PCI组的血管再通成功率为90.9%，CM组的溶栓成功率为60.7%（p=0.004）。PCI组的院内死亡率低于CM组（42.4%对65.6%，p=0.026）。Kaplan-Meier曲线显示生存率存在显著差异（48.48%对21.31%，p=0.006），支持早期PCI。多因素logistic回归分析确定从AMI发作到治疗的时间是院内死亡的独立预测因素（p=0.036）。Cox回归分析表明早期PCI是改善中期生存的独立因素（p=0.015）。
对于老年AMI合并CS患者，与初始传统药物治疗相比，急诊PCI可提高1年生存率。
