Minha Sa'ar, Barbash Israel M, Dvir Danny, Ben-Dor Itsik, Loh Joshua P, Pendyala Lakshmana K, Satler Lowell F, Pichard Augusto D, Torguson Rebecca, Waksman Ron
Interventional Cardiology, MedStar Washington Hospital Center, Washington DC.
Interventional Cardiology, MedStar Washington Hospital Center, Washington DC.
Cardiovasc Revasc Med. 2014 Jan;15(1):13-7. doi: 10.1016/j.carrev.2013.08.012.
This study aimed to explore the correlates for mortality in patients treated with both primary percutaneous coronary intervention (PCI) and intra-aortic balloon pump counter-pulsation (IABP).
Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) is associated with high mortality rates.
From a cohort of patients with AMI, treated with both primary PCI and IABP and who met strict definitions for CS to identify correlates associated with mortality, the study compared patients who died in-hospital to those who survived to discharge.
A cohort of 93 patients met the inclusion/exclusion criteria. Of them, 66.7% were male, and the average age was 64.96±13.06years. The overall in-hospital mortality rate for this cohort was 33%. The baseline characteristics were balanced save for older average age and left ventricular ejection fraction in those who died (p=0.049 and p=0.014, respectively). Insertion of IABP pre-PCI and cardiac arrest at the catheterization lab were more frequent in those who died (p=0.027 and p=0.008, respectively). The insertion of IABP pre-PCI, cardiac arrest at the cath lab, and lower ejection fraction were correlated with in-hospital mortality (ORs 2.68, 5.93, and 0.02, respectively).
In the era of primary PCI and IABP as standard of care in AMI complicated by CS, patients with low EF, those who necessitate IABP insertion pre-PCI, and those who necessitate cardiopulmonary resuscitation during PCI are at higher risk for in-hospital mortality and should be considered for more robust hemodynamic support devices with an attempt to improve their prognosis.
本研究旨在探讨接受初次经皮冠状动脉介入治疗（PCI）和主动脉内球囊反搏（IABP）的患者的死亡相关因素。
急性心肌梗死（AMI）合并心源性休克（CS）的死亡率很高。
从一组接受初次PCI和IABP治疗且符合CS严格定义的AMI患者中，确定与死亡相关的因素，该研究比较了院内死亡患者和存活至出院的患者。
一组93例患者符合纳入/排除标准。其中，66.7%为男性，平均年龄为64.96±13.06岁。该队列的总体院内死亡率为33%。除了死亡患者的平均年龄较大和左心室射血分数较低外（分别为p=0.049和p=0.014），基线特征是平衡的。死亡患者中PCI术前IABP置入和导管室心脏骤停更为常见（分别为p=0.027和p=0.008）。PCI术前IABP置入、导管室心脏骤停和较低的射血分数与院内死亡率相关（OR分别为2.68、5.93和0.02）。
在以初次PCI和IABP作为AMI合并CS标准治疗的时代，EF值低、PCI术前需要置入IABP以及PCI期间需要心肺复苏的患者院内死亡风险更高，应考虑使用更强大的血流动力学支持设备，以试图改善其预后。
