Islam Mohammad S, Panduranga Prashanth, Al-Mukhaini Mohammed, Al-Riyami Abdullah, El-Deeb Mohammad, Rahman Said Abdul, Al-Riyami Mohammed B
Department of Cardiology, Royal Hospital, Muscat, Oman.
Oman Med J. 2016 Jan;31(1):46-51. doi: 10.5001/omj.2016.09.
Cardiogenic shock (CS) is still the leading cause of in-hospital mortality in patients presenting with acute myocardial infarction (AMI). The aim of this study was to determine the in-hospital mortality and clinical outcome in AMI patients presenting with CS in a tertiary hospital in Oman.
This retrospective observational study included patients admitted to the cardiology department between January 2013 and December 2014. A purposive sampling technique was used, and 63 AMI patients with CS admitted to (36.5%) or transferred from a regional hospital (63.5%) were selected for the study.
Of 63 patients, 73% (n = 46) were Omani and 27% (n = 17) were expatriates: 79% were male and 21% were female. The mean age of patients was 60±12 years. The highest incidence of CS (30%) was observed in the 51-60 year age group. Diabetes mellitus (43%) and hypertension (40%) were the predominant risk factors. Ninety-two percent of patients had ST-elevation MI, 58.7% patients were thrombolysed, and 8% had non-ST-elevation MI. Three-quarters (75%) of CS patients had severe left ventricular systolic dysfunction (defined as ejection fraction <30%). Coronary angiogram showed single vessel disease in 17%, double vessel disease in 40%, and triple vessel disease in 32% and left main disease in 11%. The majority of the patients (93.6%) underwent percutaneous coronary intervention (PCI), among them 23 (36.5%) underwent primary PCI. In-hospital mortality was 52.4% in this study.
CS in AMI patients presenting to a tertiary hospital in Oman have high in-hospital mortality despite the majority undergoing PCI. Even though the in-hospital mortality is comparable to other studies and registries, there is an urgent need to determine the causes and find any remedies to provide better care for such patients, specifically concentrating on the early transfer of patients from regional hospitals for early PCI.
心源性休克（CS）仍是急性心肌梗死（AMI）患者院内死亡的主要原因。本研究旨在确定阿曼一家三级医院中出现CS的AMI患者的院内死亡率和临床结局。
这项回顾性观察性研究纳入了2013年1月至2014年12月间入住心内科的患者。采用了目的抽样技术，选取了63例入住（36.5%）或从地区医院转入（63.5%）的伴有CS的AMI患者进行研究。
63例患者中，73%（n = 46）为阿曼人，27%（n = 17）为外籍人士；79%为男性，21%为女性。患者的平均年龄为60±12岁。CS发病率最高（30%）的是51 - 60岁年龄组。糖尿病（43%）和高血压（40%）是主要危险因素。92%的患者为ST段抬高型心肌梗死，58.7%的患者接受了溶栓治疗，8%为非ST段抬高型心肌梗死。四分之三（75%）的CS患者有严重的左心室收缩功能障碍（定义为射血分数<30%）。冠状动脉造影显示单支血管病变占17%，双支血管病变占40%，三支血管病变占32%，左主干病变占11%。大多数患者（93.6%）接受了经皮冠状动脉介入治疗（PCI），其中23例（36.5%）接受了直接PCI。本研究中的院内死亡率为52.4%。
在阿曼一家三级医院就诊的AMI患者中的CS，尽管大多数患者接受了PCI，但院内死亡率仍很高。尽管院内死亡率与其他研究和登记数据相当，但迫切需要确定原因并找到任何补救措施，以便为这类患者提供更好的护理，尤其要专注于将患者从地区医院尽早转运以进行早期PCI。
