Kolte Dhaval, Khera Sahil, Dabhadkar Kaustubh C, Agarwal Shikhar, Aronow Wilbert S, Timmermans Robert, Jain Diwakar, Cooper Howard A, Frishman William H, Menon Venu, Bhatt Deepak L, Abbott J Dawn, Fonarow Gregg C, Panza Julio A
Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York.
Division of Cardiology, Department of Medicine, Rhode Island Hospital, Brown University, Providence, Rhode Island.
Am J Cardiol. 2016 Jan 1;117(1):1-9. doi: 10.1016/j.amjcard.2015.10.006. Epub 2015 Oct 22.
Early revascularization is the mainstay of treatment for cardiogenic shock (CS) complicating acute myocardial infarction. However, data on the contemporary trends in management and outcomes of CS complicating non-ST-elevation myocardial infarction (NSTEMI) are limited. We used the 2006 to 2012 Nationwide Inpatient Sample databases to identify patients aged ≥ 18 years with NSTEMI with or without CS. Temporal trends and differences in coronary angiography, revascularization, and outcomes were analyzed. Of 2,191,772 patients with NSTEMI, 53,800 (2.5%) had a diagnosis of CS. From 2006 to 2012, coronary angiography rates increased from 53.6% to 60.4% in patients with NSTEMI with CS (ptrend <0.001). Among patients who underwent coronary angiography, revascularization rates were significantly higher in patients with CS versus without CS (72.5% vs 62.6%, p <0.001). Patients with NSTEMI with CS had significantly higher risk-adjusted in-hospital mortality (odds ratio 10.09, 95% confidence interval 9.88 to 10.32) as compared to those without CS. In patients with CS, an invasive strategy was associated with lower risk-adjusted in-hospital mortality (odds ratio 0.43, 95% confidence interval 0.42 to 0.45). Risk-adjusted in-hospital mortality, length of stay, and total hospital costs decreased over the study period in patients with and without CS (ptrend <0.001). In conclusion, we observed an increasing trend in coronary angiography and decreasing trend in in-hospital mortality, length of stay, and total hospital costs in patients with NSTEMI with and without CS. Despite these positive trends, overall coronary angiography and revascularization rates remain less than optimal and in-hospital mortality unacceptably high in patients with NSTEMI and CS.
早期血运重建是治疗并发急性心肌梗死的心源性休克（CS）的主要方法。然而，关于并发非ST段抬高型心肌梗死（NSTEMI）的CS的当代管理趋势和结局的数据有限。我们使用2006年至2012年全国住院患者样本数据库来识别年龄≥18岁的患有或未患有CS的NSTEMI患者。分析了冠状动脉造影、血运重建和结局的时间趋势及差异。在2191772例NSTEMI患者中，53800例（2.5%）被诊断为CS。从2006年到2012年，并发CS的NSTEMI患者的冠状动脉造影率从53.6%增至60.4%（趋势P<0.001）。在接受冠状动脉造影的患者中，并发CS的患者血运重建率显著高于未并发CS的患者（72.5%对62.6%，P<0.001）。与未并发CS的患者相比，并发CS的NSTEMI患者经风险调整后的住院死亡率显著更高（比值比10.09，95%置信区间9.88至10.32）。在并发CS的患者中，侵入性策略与经风险调整后的较低住院死亡率相关（比值比0.43，95%置信区间0.42至0.45）。在研究期间，并发和未并发CS的患者经风险调整后的住院死亡率、住院时间和总住院费用均下降（趋势P<0.001）。总之，我们观察到并发和未并发CS的NSTEMI患者的冠状动脉造影呈上升趋势，住院死亡率、住院时间和总住院费用呈下降趋势。尽管有这些积极趋势，但总体冠状动脉造影和血运重建率仍未达到最佳，NSTEMI并发CS患者的住院死亡率高得令人无法接受。
