Dziewierz Artur, Siudak Zbigniew, Rakowski Tomasz, Dubiel Jacek S, Dudek Dariusz
2nd Department of Cardiology.
Acute Card Care. 2010 Mar;12(1):3-9. doi: 10.3109/17482941003637106.
The purpose was to identify predictors of cardiogenic shock (CS) on admission and to asses associations between CS and real-life management patterns and outcomes in unselected cohort of acute coronary syndrome (ACS) patients admitted to hospitals without onsite invasive facilities.
Data concerning in-hospital management and mortality of 56 (4.3%) patients with and 1257 (95.7%) without CS on hospital admission was assessed.
Prior myocardial infarction, prior heart failure symptoms, age, and diabetes mellitus were independently associated with increased risk of CS on admission. A total of 23.8% patients were transferred for invasive treatment during index hospital stay and the frequency of transfer was similar among patients with and without CS on admission (21.4% versus 23.9%; P = 0.75), but in the STEMI subgroup, patients with shock were transported less frequently (21.4% versus 43.8%; P = 0.0027). CS patients were less likely to receive guideline-recommended therapies including antiplatelet drugs, statins, and beta-blockers. In-hospital mortality was lower in non-shock patients (6.2% versus 63.6%; P < 0.001) and CS on admission was an independent predictor of in-hospital death.
CS on admission is an important determinant of treatment strategy selection and is associated with unfavorable prognosis of ACS patients admitted to hospitals without on-site invasive facilities.
目的是确定急性冠状动脉综合征（ACS）患者入院时心源性休克（CS）的预测因素，并评估CS与现实生活中的管理模式及结局之间的关联，这些患者来自未配备现场侵入性设备的医院。
评估了56例（4.3%）入院时发生CS和1257例（95.7%）未发生CS的患者的院内管理及死亡率数据。
既往心肌梗死、既往心力衰竭症状、年龄和糖尿病与入院时CS风险增加独立相关。共有23.8%的患者在索引住院期间被转运接受侵入性治疗，入院时发生CS和未发生CS的患者转运频率相似（21.4%对23.9%；P = 0.75），但在ST段抬高型心肌梗死（STEMI）亚组中，休克患者的转运频率较低（21.4%对43.8%；P = 0.0027）。CS患者接受指南推荐治疗（包括抗血小板药物、他汀类药物和β受体阻滞剂）的可能性较小。非休克患者的院内死亡率较低（6.2%对63.6%；P < 0.001），入院时CS是院内死亡的独立预测因素。
入院时CS是治疗策略选择的重要决定因素，并且与未配备现场侵入性设备的医院中ACS患者的不良预后相关。
