Jeger Raban V, Urban Philip, Harkness Shannon M, Tseng Chi-Hong, Stauffer Jean-Christophe, Lejemtel Thierry H, Sleeper Lynn A, Pfisterer Matthias E, Hochman Judith S
Cardiovascular Clinical Research Center, New York University School of Medicine, New York, NY, USA.
Acute Card Care. 2011 Mar;13(1):14-20. doi: 10.3109/17482941.2010.538696. Epub 2011 Jan 18.
A pooled analysis in cardiogenic shock due to acute coronary syndromes is desirable to assess the effect of early revascularization (ERV) across all ages and a wide spectrum of disease severity.
Only two randomized controlled trials (RCT), i.e. SMASH and SHOCK, met the inclusion criteria and were combined for a pooled analysis using individual patient data (n = 348).
SMASH patients (n = 54, 16%) had more severe disease than SHOCK patients (n = 294, 84%). After adjustment for age, anoxic brain damage, non-inferior myocardial infarction, prior coronary artery bypass graft surgery, renal failure, systolic blood pressure, and selection for coronary angiography, one-year mortality was similar (relative risk SHOCK versus SMASH 0.87, 95% CI: 0.61-1.25). Relative risk of one-year death for ERV versus initial medical stabilization was 0.82 (95% CI: 0.70-0.96). There was no significant difference in the treatment effect by age (≤75 years relative risk at one year 0.79, 95% CI: 0.63-0.99; > 75 years relative risk at one year 0.93, 95% CI: 0.56-1.53; interaction P = 0.10).
Only two RCT have been published emphasizing the difficulty of enrolling critically ill patients. Despite large differences in shock severity, ERV benefit is similar across all ages and not significantly different for the elderly.
对急性冠状动脉综合征所致心源性休克进行汇总分析，有助于评估早期血运重建（ERV）在所有年龄段及广泛疾病严重程度范围内的效果。
仅有两项随机对照试验（RCT），即SMASH和SHOCK，符合纳入标准，遂使用个体患者数据（n = 348）进行汇总分析。
SMASH组患者（n = 54，16%）的病情比SHOCK组患者（n = 294，84%）更为严重。在对年龄、缺氧性脑损伤、非ST段抬高型心肌梗死、既往冠状动脉旁路移植手术、肾衰竭、收缩压以及冠状动脉造影选择等因素进行校正后，两组的一年死亡率相似（SHOCK组与SMASH组的相对风险为0.87，95%可信区间：0.61 - 1.25）。ERV与初始药物稳定治疗相比，一年死亡的相对风险为0.82（95%可信区间：0.70 - 0.96）。年龄对治疗效果无显著差异（≤75岁患者一年相对风险为0.79，95%可信区间：0.63 - 0.99；>75岁患者一年相对风险为0.93，95%可信区间：0.56 - 1.53；交互作用P = 0.10）。
仅发表了两项随机对照试验，凸显了纳入重症患者的难度。尽管休克严重程度差异很大，但ERV的益处在所有年龄段相似，老年人也无显著差异。
