Metkus Thomas S, Albaeni Aiham, Chandra-Strobos Nisha, Eid Shaker M
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Am J Cardiol. 2017 Jan 15;119(2):171-177. doi: 10.1016/j.amjcard.2016.09.037. Epub 2016 Oct 8.
Data addressing the use of respiratory support in acute coronary syndromes are lacking. To address this evidence gap, we characterized prognostic impact and trends in utilization of invasive mechanical ventilation (IMV) and noninvasive ventilation (NIV) in patients hospitalized with ST-segment elevation myocardial infarction (STEMI) from 2002 through 2013 using the National Inpatient Sample. Multivariate logistic regression was performed to identify patient, hospital, and clinical characteristics associated with requiring IMV or NIV within 24 hours of hospitalization. Multivariate Cox proportional hazards regression was used to quantify the magnitude of in-hospital mortality associated with IMV and NIV use. From 2002 to 2013, we identified 1,867,114 patients with STEMI. Age, gender, higher co-morbidity burden, and chronic pulmonary disease were significantly associated with need for respiratory support. The use of IMV and NIV increased at average annual rates of 6.6% and 14.3%, respectively (p <0.001). Age- and gender-adjusted mortality rates are high but declined for patients with STEMI requiring IMV (44.7% in 2002 to 37.6% in 2013, p = 0.002) and NIV (11.6% in 2002 to 6.8% in 2013, p <0.001). Compared to patients with STEMI with no ventilation need, a requirement for IMV or NIV was associated with increased adjusted in-hospital mortality (hazard ratio 2.5, p <0.001 and 1.7, p <0.001, respectively). In conclusion, approximately 1 in 23 patients hospitalized with STEMI will require respiratory support in the form of IMV or NIV. Patients with STEMI who require respiratory support have a high risk of death, although rates of in-hospital mortality have decreased over time.
关于急性冠状动脉综合征中呼吸支持使用情况的数据尚缺。为填补这一证据空白，我们利用全国住院患者样本，对2002年至2013年因ST段抬高型心肌梗死（STEMI）住院的患者进行有创机械通气（IMV）和无创通气（NIV）使用情况的预后影响及趋势分析。进行多因素逻辑回归以确定与住院24小时内需要IMV或NIV相关的患者、医院和临床特征。使用多因素Cox比例风险回归来量化与IMV和NIV使用相关的院内死亡率。2002年至2013年，我们共识别出1,867,114例STEMI患者。年龄、性别、较高的合并症负担和慢性肺病与呼吸支持需求显著相关。IMV和NIV的使用分别以6.6%和14.3%的年均增长率增加（p<0.001）。年龄和性别调整后的死亡率较高，但对于需要IMV的STEMI患者有所下降（2002年为44.7%，2013年为37.6%，p = 0.002），对于需要NIV的患者也有所下降（2002年为11.6%，2013年为6.8%，p<0.001）。与无通气需求的STEMI患者相比，需要IMV或NIV与调整后的院内死亡率增加相关（风险比分别为2.
