All authors: Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA.
Crit Care Med. 2018 May;46(5):e359-e363. doi: 10.1097/CCM.0000000000002995.
Acute myocardial infarction is the most common cause of cardiogenic shock. Although the number of patients with acute myocardial infarction complicated by cardiogenic shock who were treated with venoarterial extracorporeal membrane oxygenation increased during the last decade, detailed data on survival are lacking. We sought to analyze covariates that were independently associated with survival in this patient population and to externally validate the newly developed prEdictioN of Cardiogenic shock OUtcome foR Acute myocardial infarction patients salvaGed by venoarterial Extracorporeal membrane oxygenation (ENCOURAGE) score.
Retrospective clinical study.
A single academic teaching hospital.
Adult patients with acute myocardial infarction complicated by cardiogenic shock who were supported by venoarterial extracorporeal membrane oxygenation from June 2008 to September 2016.
Fourteen individual variables were assessed for their association with the primary endpoint. These variables were prespecified by the study team as being the most likely to affect survival. A receiver operating characteristic analysis was also performed to test the ability of the ENCOURAGE score to predict survival in this patient cohort.
The primary endpoint of the study was in-hospital survival. A total of 61 patients were included in the analysis. Thirty-seven (60.7%) could be weaned from venoarterial extracorporeal membrane oxygenation and 36 (59.0%) survived. Survival was significantly higher in patients less than 65 years old (odds ratio, 14.6 [CI, 2.5-84.0]; p = 0.003), whose body mass index was less than 32 kg/m (odds ratio, 5.5 [CI, 1.2-25.4]; p = 0.029) and international normalized ratio was less than 2 (odds ratio, 7.3 [CI, 1.3-40.1]; p = 0.022). In patients where the first lactate drawn was less than 3 mmol/L, the survival was not significantly higher (odds ratio, 4.4 [CI, 0.6-32.6]; p = 0.147). The C-statistic for predicting survival using a modified version of the ENCOURAGE score, which replaced prothrombin activity less than 50% with an international normalized ratio greater than 2, was 0.74 (95% CI, 0.61-0.87).
In this single-center study, several important covariates were associated with improved survival in patients with acute myocardial infarction complicated by cardiogenic shock who were supported by venoarterial extracorporeal membrane oxygenation and the ENCOURAGE score was found to be externally valid for predicting survival to hospital discharge.
急性心肌梗死是心源性休克最常见的原因。尽管过去十年接受静脉动脉体外膜肺氧合治疗的急性心肌梗死合并心源性休克患者数量有所增加，但缺乏有关此类患者生存情况的详细数据。我们试图分析与该患者人群生存相关的独立协变量，并对外科治疗的急性心肌梗死合并心源性休克患者体外膜肺氧合（ENCOURAGE）评分预测心源性休克预后的新预测因子（prEdictioN of Cardiogenic shock OUtcome foR Acute myocardial infarction patients salvaGed by venoarterial Extracorporeal membrane oxygenation，ENCOURAGE）进行外部验证。
回顾性临床研究。
一家学术教学医院。
2008 年 6 月至 2016 年 9 月接受静脉动脉体外膜肺氧合支持的急性心肌梗死合并心源性休克的成年患者。
评估了 14 个个体变量与主要终点的相关性。这些变量是由研究小组预先确定的，因为它们最有可能影响生存。还进行了受试者工作特征分析，以测试 ENCOURAGE 评分在该患者队列中预测生存的能力。
该研究的主要终点为院内生存率。共纳入 61 例患者进行分析。37 例（60.7%）可从静脉动脉体外膜肺氧合中脱机，36 例（59.0%）存活。年龄小于 65 岁的患者生存率明显更高（优势比，14.6[CI，2.5-84.0]；p = 0.003），其体重指数小于 32 kg/m（优势比，5.5[CI，1.2-25.4]；p = 0.029）和国际标准化比值小于 2（优势比，7.3[CI，1.3-40.1]；p = 0.022）。首次抽取的血乳酸值小于 3 mmol/L 的患者生存率没有明显提高（优势比，4.4[CI，0.6-32.6]；p = 0.147）。使用替代凝血酶原活性<50%为国际标准化比值>2 的改良版 ENCOURAGE 评分预测生存的 C 统计量为 0.74（95%CI，0.61-0.87）。
在这项单中心研究中，一些重要的协变量与接受静脉动脉体外膜肺氧合治疗的急性心肌梗死合并心源性休克患者的生存率提高相关，并且发现 ENCOURAGE 评分可用于预测患者出院时的生存情况，其具有外部有效性。
