主动脉内球囊反搏对 ST 段抬高型心肌梗死合并心原性休克患者短期临床结局的影响：一项“真实世界”单中心经验。

Impact of intra-aortic balloon pump on short-term clinical outcomes in ST-elevation myocardial infarction complicated by cardiogenic shock: A "real life" single center experience.

机构信息

Cardiology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.

出版信息

Med Intensiva. 2017 Mar;41(2):86-93. doi: 10.1016/j.medin.2016.06.009. Epub 2016 Sep 17.

DOI:10.1016/j.medin.2016.06.009

PMID:27650459

Abstract

OBJECTIVE

To analyze the use and impact of the intra-aortic balloon pump (IABP) upon the 30-day mortality rate and short-term clinical outcome of non-selected patients with ST-elevation acute myocardial infarction (acute STEMI) complicated by cardiogenic shock (CS).

DESIGN

A single-center retrospective case-control study was carried out.

SETTING

Coronary Care Unit.

PATIENTS

Data were collected from 825 consecutive patients with acute STEMI admitted to a Coronary Care Unit from January 2009 to August 2015. Seventy-three patients with CS upon admission subjected to emergency percutaneous coronary intervention (PCI) were finally included in the analysis and were stratified according to IABP use (44 patients receiving IABP).

VARIABLES

Cardiovascular history, hemodynamic situation upon admission, angiographic and procedural characteristics, and variables derived from admission to the Coronary Care Unit.

RESULTS

Cumulative 30-day mortality was similar in the patients subjected to IABP and in those who received conventional medical therapy only (29.5% and 27.6%, respectively; HR with IABP 1.10, 95% CI 0.38-3.11; p=0.85). Similarly, no significant differences were found in terms of the short-term clinical outcome between the groups: time on mechanical ventilation, days to hemodynamic stabilization, vasoactive drug requirements and stay in the Coronary Care Unit. Poorer renal function (HR 3.9, 95% CI 1.4-10.6; p=0.008), known peripheral artery disease (HR 3.3, 95% CI 1.2-9.1; p=0.019) and a history of diabetes mellitus (HR 3.2, 95% CI 1.2-8.1; p=0.018) were the only variables independently associated to increased 30-day mortality.

CONCLUSION

In our "real life" experience, IABP does not modify 30-day mortality or the short-term clinical outcome in patients presenting STEMI complicated with CS and subjected to emergency percutaneous coronary revascularization.

摘要

目的

分析主动脉内球囊反搏（IABP）在非选择性 ST 段抬高型急性心肌梗死（急性 STEMI）合并心源性休克（CS）患者中的应用及其对 30 天死亡率和短期临床结局的影响。

设计

单中心回顾性病例对照研究。

地点

冠心病监护病房。

患者

本研究纳入了 2009 年 1 月至 2015 年 8 月期间连续收治于冠心病监护病房的 825 例急性 STEMI 患者。最终纳入 73 例入院时发生 CS 且接受紧急经皮冠状动脉介入治疗（PCI）的患者，根据 IABP 使用情况将其分为两组（44 例使用 IABP 患者和 29 例未使用 IABP 患者）。

变量

心血管病史、入院时的血液动力学状况、血管造影和手术特征以及入住冠心病监护病房后的相关变量。

结果

使用 IABP 组和未使用 IABP 组的患者 30 天死亡率相似（分别为 29.5%和 27.6%；IABP 组 HR 为 1.10，95%CI 为 0.38-3.11；p=0.85）。两组患者的短期临床结局也无显著差异：机械通气时间、血液动力学稳定时间、血管活性药物需求和冠心病监护病房住院时间。肾功能更差（HR 3.9，95%CI 1.4-10.6；p=0.008）、已知外周动脉疾病（HR 3.3，95%CI 1.2-9.1；p=0.019）和糖尿病史（HR 3.2，95%CI 1.2-8.1；p=0.018）是唯一与 30 天死亡率增加相关的独立变量。