Allou Nicolas, Brulliard Caroline, Valance Dorothée, Esteve Jean Baptiste, Martinet Olivier, Corradi Laure, Cordier Charlotte, Bouchet Bruno, Allyn Jérôme
Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint Denis, France.
Cardiologie, Centre Hospitalier Universitaire Félix Guyon, Saint Denis, France.
J Crit Care. 2016 Apr;32:159-64. doi: 10.1016/j.jcrc.2015.12.014. Epub 2016 Jan 4.
It is difficult to differentiate type 1 acute myocardial infarction (AMI) with obstructive coronary artery disease (OCAD) from type 2 AMI in patients admitted for severe sepsis. The aims of this study were to assess the risk factors and prognosis of OCAD in patients admitted to the intensive care unit for severe sepsis with concomitant AMI.
This is a single-center retrospective cohort study including all consecutive patients who were hospitalized for severe sepsis or septic shock between March 2006 and September 2014 and who underwent coronary angiography in the intensive care unit to identify AMI.
Overall, 78 (5.5%) of 1418 patients hospitalized for severe sepsis underwent coronary angiography to identify concomitant AMI. Thirty-two patients (41%) had OCAD. Following multivariate analysis, the risk factors of OCAD were peripheral vascular disease (odds ratio [OR] =5.7; 95% confidence interval [CI], 1.1-30.4; P = .042) and at least 2 cardiovascular risk factors (OR = 6.7; 95% CI, 1.9-23.8; P = .003). Obstructive coronary artery disease was associated with a significant mortality increase at 60 days (OR = 8.1; 95% CI, 1.9-30.2; P = .004).
Obstructive coronary artery disease is a poor prognosis factor in patients hospitalized for severe sepsis with concomitant AMI. In this setting, medical treatment should be considered for patients with peripheral vascular disease or with at least 2 cardiovascular risk factors; the need to perform coronary angiography should be considered carefully.
在因严重脓毒症入院的患者中，很难将1型急性心肌梗死（AMI）合并阻塞性冠状动脉疾病（OCAD）与2型AMI区分开来。本研究的目的是评估因严重脓毒症合并AMI入住重症监护病房的患者发生OCAD的危险因素和预后。
这是一项单中心回顾性队列研究，纳入了2006年3月至2014年9月期间因严重脓毒症或感染性休克住院并在重症监护病房接受冠状动脉造影以确定是否合并AMI的所有连续患者。
总体而言，1418例因严重脓毒症住院的患者中有78例（5.5%）接受了冠状动脉造影以确定是否合并AMI。32例患者（41%）患有OCAD。多因素分析后，OCAD的危险因素为外周血管疾病（比值比[OR]=5.7；95%置信区间[CI]，1.1-30.4；P=0.042）和至少2种心血管危险因素（OR=6.7；95%CI，1.9-23.8；P=0.003）。阻塞性冠状动脉疾病与60天时死亡率显著增加相关（OR=8.1；95%CI，1.9-30.2；P=0.004）。
阻塞性冠状动脉疾病是因严重脓毒症合并AMI住院患者预后不良的因素。在这种情况下，对于患有外周血管疾病或至少有2种心血管危险因素的患者应考虑药物治疗；应谨慎考虑是否需要进行冠状动脉造影。
