Valente Serafina, Lazzeri Chiara, Chiostri Marco, Sori Andrea, Giglioli Cristina, Salvadori Claudia, Gensini Gian Franco
Intensive Cardiac Care Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
J Cardiovasc Med (Hagerstown). 2008 Dec;9(12):1235-40. doi: 10.2459/JCM.0b013e3283168a27.
The aim of our study was to evaluate the incidence, timing of the onset and outcome of cardiogenic shock in a group of 865 patients with acute coronary syndromes who were consecutively admitted to our Intensive Cardiac Care Unit (ICCU) from January 2004 to December 2005.
Eighty-seven patients had cardiogenic shock; 65 (74.7%, 65/87) on ICCU admission ('early' cardiogenic shock) and 22 (25.3%, 22/87) during ICCU stay ('delayed' cardiogenic shock). Left ventricular systolic dysfunction was the cause of cardiogenic shock in 90.7% of patients (59/65) with early cardiogenic shock and in 50% of patients (11/22) with delayed cardiogenic shock (P < 0.001). Patients with early shock exhibited higher serum levels of troponin I (P = 0.029), higher serum levels of glucose on admission (P = 0.009), lower ejection fraction (=0.003), whereas latency (time from symptoms onset to percutaneous coronary intervention) was higher in patients with delayed shock (P = 0.032). Intra-ICCU mortality was comparable in the two subgroups of patients. At multivariable logistic regression analysis, age, percutaneous coronary intervention failure, glycemia on admission and the development of mechanical complications were independent predictors of intra-ICCU mortality.
Primary percutaneous coronary intervention has reduced the number of patients who develop cardiogenic shock after ICCU admission. According to our results, cardiogenic shock in patients with ST-elevation myocardial infarction developed early after symptoms' onset and, despite optimal treatment, mortality in these patients remains high (about 50%). Delayed cardiogenic shock is mainly due to mechanical complications as well as due to PCI complications.
我们研究的目的是评估2004年1月至2005年12月期间连续入住我们心脏重症监护病房（ICCU）的865例急性冠脉综合征患者的心源性休克发生率、发病时间及预后。
87例患者发生心源性休克；65例（74.7%，65/87）在入住ICCU时发生（“早期”心源性休克），22例（25.3%，22/87）在ICCU住院期间发生（“延迟”心源性休克）。90.7%的早期心源性休克患者（59/65）和50%的延迟心源性休克患者（11/22）的心源性休克病因是左心室收缩功能障碍（P<0.001）。早期休克患者的肌钙蛋白I血清水平较高（P = 0.029），入院时血糖水平较高（P = 0.009），射血分数较低（P = 0.003），而延迟休克患者的潜伏期（从症状发作到经皮冠状动脉介入治疗的时间）较长（P = 0.032）。两个亚组患者的ICCU内死亡率相当。在多变量逻辑回归分析中，年龄、经皮冠状动脉介入治疗失败、入院时血糖水平和机械并发症的发生是ICCU内死亡率的独立预测因素。
直接经皮冠状动脉介入治疗减少了ICCU入院后发生心源性休克的患者数量。根据我们的结果，ST段抬高型心肌梗死患者的心源性休克在症状发作后早期发生，尽管进行了最佳治疗，这些患者的死亡率仍然很高（约50%）。延迟心源性休克主要归因于机械并发症以及经皮冠状动脉介入治疗并发症。
