Kalavrouziotis Dimitri, Rodés-Cabau Josep, Mohammadi Siamak
Department of Cardiac Surgery, Quebec Heart and Lung Institute, Québec City, Québec, Canada.
Department of Cardiology, Quebec Heart and Lung Institute, Québec City, Québec, Canada.
Can J Cardiol. 2017 Jan;33(1):36-43. doi: 10.1016/j.cjca.2016.10.018. Epub 2016 Oct 24.
The current management of patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) is associated with a high rate of mortality, despite widespread regional implementation of rapid transfer to percutaneous coronary intervention-capable centres for prompt infarct-related artery reperfusion. The limited clinical effectiveness of early revascularization in patients with AMI-CS might be secondary to the extent of coronary artery disease in these patients and the risk of incomplete revascularization, as well as the lower probability of achieving successful reperfusion compared with acute myocardial infarction without hemodynamic instability. Also, the severity of end-organ injury is a critical determinant of outcome. We review adjunctive therapies to early revascularization in AMI-CS, specifically with a focus on the role of short-term mechanical circulatory support. In selected patients with AMI-CS, there might be a benefit associated with early institution of mechanical circulatory support before revascularization.
目前，急性心肌梗死合并心源性休克（AMI-CS）患者的管理与高死亡率相关，尽管在广泛区域实施了快速转运至具备经皮冠状动脉介入治疗能力的中心以迅速实现梗死相关动脉再灌注。AMI-CS患者早期血运重建的临床效果有限，可能是由于这些患者的冠状动脉疾病程度、不完全血运重建的风险，以及与无血流动力学不稳定的急性心肌梗死相比，成功再灌注的概率较低。此外，终末器官损伤的严重程度是预后的关键决定因素。我们回顾了AMI-CS早期血运重建的辅助治疗方法，特别关注短期机械循环支持的作用。在选定的AMI-CS患者中，在血运重建前早期应用机械循环支持可能有益。
