Castillo Costa Yanina, Mauro Víctor M, García Aurelio Mauro, Barrero Carlos, Charask Adrián, Gagliardi Juan A
área de Investigación y Consejo de Emergencias Cardiovasculares, Sociedad Argentina de Cardiología (SAC), Buenos Aires, Argentina. E-mail:
área de Investigación y Consejo de Emergencias Cardiovasculares, Sociedad Argentina de Cardiología (SAC), Buenos Aires, Argentina.
Medicina (B Aires). 2017;77(4):261-266.
Cardiogenic shock (CS) in the setting of an ST-segment elevation myocardial infarction (STEMI) is a severe complication and constitutes one of the principal causes of death associated with this condition. The aim of this study was to describe the clinical characteristics, treatment strategies and hospital outcome of CS associated with STEMI in Argentina. The Argentine Registry of Cardiogenic Shock (ReNA-Shock) was a prospective and multicenter registry of consecutive patients with CS hospitalized in 64 centers in Argentina between July 2013 and May 2015. Only those with ST-segment elevation myocardial infarction (STEMI) were selected for this analysis. Of the 165 patients included in the ReNa-Shock registry, 124 presented STEMI. Median age was 64 years (IQR 25-75: 56.5-75) and 67% were men; median time from symptom onset to admission was 240 minutes (IQR 25-75: 132-720). 63% of the cases presented CS at admission. Eighty-seven percent underwent reperfusion therapy: 80% primary percutaneous intervention with a median door-to-balloon time of 110 minutes (IQR 25-75: 62-184). Inotropic agents were used in 96%; 79% required mechanical ventilation; a Swan Ganz catheter was inserted in 47% and 35% required intra-aortic balloon pumping. Most patients (59%) presented multivessel disease (MV). Hospital mortality was 54%. Multivariate analysis identified that time from symptom onset to admission (> 240 min) was the only independent predictor of mortality (OR: 3.04; CI 95%: 1.18-7.9). Despite using treatment strategies currently available, morbidity and mortality of STEMI complicated with CS remains high.
ST 段抬高型心肌梗死（STEMI）合并的心源性休克（CS）是一种严重并发症，也是该疾病相关的主要死亡原因之一。本研究的目的是描述阿根廷 STEMI 合并 CS 的临床特征、治疗策略及住院结局。阿根廷心源性休克登记处（ReNA-Shock）是一项前瞻性多中心登记研究，纳入了 2013 年 7 月至 2015 年 5 月期间在阿根廷 64 个中心住院的连续 CS 患者。本分析仅选取 ST 段抬高型心肌梗死（STEMI）患者。在 ReNa-Shock 登记处纳入的 165 例患者中，124 例为 STEMI。中位年龄为 64 岁（四分位间距 25 - 75：56.5 - 75），67%为男性；症状发作至入院的中位时间为 240 分钟（四分位间距 25 - 75：132 - 720）。63%的病例入院时即出现 CS。87%的患者接受了再灌注治疗：80%接受了直接经皮冠状动脉介入治疗，中位门球时间为 110 分钟（四分位间距 25 - 75：62 - 184）。96%的患者使用了正性肌力药物；79%的患者需要机械通气；47%的患者插入了 Swan Ganz 导管，35%的患者需要主动脉内球囊反搏。大多数患者（59%）存在多支血管病变（MV）。住院死亡率为 54%。多变量分析确定症状发作至入院时间（>240 分钟）是唯一的独立死亡预测因素（比值比：3.04；95%置信区间：1.18 - 7.9）。尽管采用了目前可用的治疗策略，STEMI 合并 CS 的发病率和死亡率仍然很高。
