Goldberg R J, Gore J M, Alpert J S, Osganian V, de Groot J, Bade J, Chen Z, Frid D, Dalen J E
Department of Medicine, University of Massachusetts Medical School, Worcester 01655.
N Engl J Med. 1991 Oct 17;325(16):1117-22. doi: 10.1056/NEJM199110173251601.
Cardiogenic shock resulting from acute myocardial infarction is a serious complication with a high mortality rate, but little is known about whether its incidence or outcome has changed over time. As part of an ongoing population-based study of acute myocardial infarction, we examined trends over time in the incidence and mortality rate of cardiogenic shock after acute myocardial infarction.
We studied 4762 patients with acute myocardial infarction who were admitted to 16 hospitals in the Worcester, Massachusetts, metropolitan area between 1975 and 1988. We determined the incidence of and short-term and long-term mortality due to cardiogenic shock in each of six years during this study period.
The incidence of cardiogenic shock complicating acute myocardial infarction remained relatively constant, averaging 7.5 percent. Multivariate regression analysis that controlled for variables affecting incidence revealed significant though inconsistent temporal trends in the incidence of cardiogenic shock. As compared with the risk in 1975, the adjusted relative risk (with 95 percent confidence interval) was 0.83 (0.54 to 1.28) in 1978, 0.96 (0.63 to 1.48) in 1981, 0.68 (0.42 to 1.12) in 1984, 1.16 (0.70 to 1.92) in 1986, and 1.65 (0.99 to 2.77) in 1988. The overall in-hospital mortality rate among patients with cardiogenic shock was significantly higher than that among patients without this complication (77.7 percent vs. 13.5 percent, P less than 0.001). The in-hospital mortality among the patients with shock did not improve between 1975 (73.7 percent) and 1988 (81.7 percent). Long-term survival during the 14-year follow-up period was significantly worse among patients who survived cardiogenic shock during hospitalization than among patients who did not have shock (P less than 0.001).
The results of this observational, community-wide study suggest that neither the incidence nor the prognosis of cardiogenic shock resulting from acute myocardial infarction has improved over time. Both in-hospital and long-term survival remain poor for patients with this complication.
急性心肌梗死所致的心源性休克是一种严重并发症，死亡率很高，但对于其发病率或预后随时间推移是否发生变化却知之甚少。作为一项正在进行的基于人群的急性心肌梗死研究的一部分，我们研究了急性心肌梗死后心源性休克发病率和死亡率随时间的变化趋势。
我们研究了1975年至1988年间在马萨诸塞州伍斯特市大都市区16家医院收治的4762例急性心肌梗死患者。我们确定了研究期间每六年中心源性休克的发病率以及短期和长期死亡率。
急性心肌梗死并发心源性休克的发病率保持相对稳定，平均为7.5%。控制影响发病率的变量后的多变量回归分析显示，心源性休克发病率存在显著但不一致的时间趋势。与1975年的风险相比，1978年调整后的相对风险（95%置信区间）为0.83（0.54至1.28），1981年为0.96（0.63至1.48），1984年为0.68（0.42至1.12），1986年为1.16（0.70至1.92），1988年为1.65（0.99至2.77）。心源性休克患者的总体住院死亡率显著高于无此并发症的患者（77.7%对13.5%，P<0.001）。1975年（73.7%）至1988年（81.7%）期间，休克患者的住院死亡率没有改善。在14年的随访期内，住院期间存活的心源性休克患者的长期生存率显著低于未发生休克的患者（P<0.001）。
这项观察性的社区范围研究结果表明，急性心肌梗死所致的心源性休克的发病率和预后均未随时间推移而改善。该并发症患者的住院和长期生存率仍然很低。
