Section of Cardiology Dept. of Cardiac Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Catheter Cardiovasc Interv. 2011 Oct 1;78(4):540-8. doi: 10.1002/ccd.23006. Epub 2011 May 5.
To identify predictors of survival in a retrospective multicentre cohort of patients with cardiogenic shock undergoing coronary angiography and to address whether complete revascularization is associated with improved survival in this cohort.
Early revascularization is the standard of care for cardiogenic shock. Coronary bypass grafting and percutaneous intervention have complimentary roles in achieving this revascularization.
A total of 210 consecutive patients (mean age 66 ± 12 years) at two tertiary centres from 2002 to 2006 inclusive with a diagnosis of cardiogenic shock were evaluated. Univariate and multivariate predictors of in-hospital survival were identified utilizing logistic regression.
ST elevation infarction occurred in 67% of patients. Thrombolysis was administered in 34%, PCI was attempted in 62% (88% stented, 76% TIMI 3 flow), CABG was performed in 22% (2.7 grafts, 14 valve procedures), and medical therapy alone was administered to the remainder. The overall survival to discharge was 59% (CABG 68%, PCI 57%, medical 48%). Independent predictors of mortality included complete revascularization (P = 0.013, OR = 0.26 (95% CI: 0.09-0.76), hyperlactatemia (P = 0.046, OR = 1.14 (95% CI: 1.002-1.3) per mmol increase), baseline renal insufficiency (P = 0.043, OR = 3.45, (95% CI: 1.04-11.4), and the presence of anoxic brain injury (P = 0.008, OR = 8.22 (95% CI: 1.73-39.1). Within the STEMI with concomitant multivessel coronary disease subgroup of this population (N = 101), independent predictors of survival to discharge included complete revascularization (P = 0.03, OR = 2.5 (95% CI: 1.1-6.2)) and peak lactate (P = 0.02).
The ability to achieve complete revascularization may be strongly associated with improved in-hospital survival in patients with cardiogenic shock.
确定接受冠状动脉造影的充血性休克患者的回顾性多中心队列中的生存预测因素，并探讨在该队列中完全血运重建是否与生存率的提高相关。
早期血运重建是充血性休克的标准治疗方法。冠状动脉旁路移植术和经皮介入治疗在实现这种血运重建方面具有互补作用。
纳入了 2002 年至 2006 年期间在两个三级中心的 210 例连续确诊为充血性休克的患者（平均年龄 66±12 岁），利用逻辑回归识别了院内生存率的单因素和多因素预测因素。
ST 段抬高型心肌梗死发生在 67%的患者中。34%的患者接受了溶栓治疗，62%的患者进行了 PCI（88%支架，76% TIMI 3 级血流），22%的患者进行了 CABG（2.7 个桥血管，14 个瓣膜手术），其余患者接受了单纯药物治疗。出院时的总体生存率为 59%（CABG 为 68%，PCI 为 57%，药物治疗为 48%）。死亡率的独立预测因素包括完全血运重建（P=0.013，OR=0.26（95%CI：0.09-0.76））、高乳酸血症（P=0.046，OR=1.14（95%CI：1.002-1.3）/mmol 增加）、基线肾功能不全（P=0.043，OR=3.45（95%CI：1.04-11.4））和缺氧性脑损伤（P=0.008，OR=8.22（95%CI：1.73-39.1））。在该人群中 STEMI 伴同时多支冠状动脉疾病的亚组（N=101）中，出院时生存率的独立预测因素包括完全血运重建（P=0.03，OR=2.5（95%CI：1.1-6.2））和峰值乳酸（P=0.02）。
在充血性休克患者中，实现完全血运重建的能力可能与院内生存率的提高密切相关。
