Wu N Q, Gao Z, Zheng Y, Li W, Li J N, Xu H Y, Cheng X S, Wu Y, Wang Y, Wang Z J, Yang J G, Yang Y J
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2018 Jan 24;46(1):26-31. doi: 10.3760/cma.j.issn.0253-3758.2018.01.005.
To investigate the current status of application of intra-aortic balloon pump(IABP) and analyze the factors which might impact the application of IABP in patients with acute myocardial infarction complicated with cardiac shock in China. In China Acute Myocardial Infarction (CAMI) Registry,a nationwide, multicenter(107 hospitals), prospective study, 26 592 patients with acute myocardial infarction were enrolled consecutively between January 1, 2013 and September 30, 2014. After excluding of 30 cases due to missing important data,26 562 cases were analyzed.The application status of IABP was analyzed and multivariate logistic regression analysis was performed to determine the factors related to IABP application. A total of 785(3.0%) patients with acute myocardial infarction received IABP implantation, and 381(49.9%) patients belonged to preventive application of IABP before primary percutaneous coronary intervention,and 6(0.8%) patients were complicated with mechanical complications.There were 118(15.0%) patients with cardiac shock received IABP implantation, which accounted for 12.0%(118/984) of all patients with cardiac shock.Multivariate logistic regression analysis showed that the clinical independent factors of the decision of IABP insertion included dyslipidemia (2.858, 95% 1.397-5.846, 0.004),left ventricular ejection fraction (0.977, 95% 0.961-0.994, 0.009),usage of dopamine (2.817, 95% 1.495-5.308, 0.001), left main disease (2.817, 95% 1.495-5.308, 0.001), GRACE score (1.006, 95% 1.000-1.011, 0.034), receiving primary percutaneous coronary intervention (4.508, 95% 1.673-12.146, 0.003), teritiary hospitals (2.562, 95% 1.498-4.384, 0.001), and higher education of the patients (2.183, 95% 1.056-4.509, 0.016). Among the Chinese acute myocardial infarction patients who received IABP implantation, nearly half application of IABP are preventive implantation before primary percutaneous coronary intervention. Only a few patients complicated with cardiac shock received IABP insertion. The clinical conditions, grade of hospitals, degree of education impact the decision of IABP insertion for the patients with acute myocardial infarction. Clinical Trial Registry National Institutes of Health, NCT018746.
为调查主动脉内球囊反搏（IABP）的应用现状，并分析在中国急性心肌梗死合并心源性休克患者中可能影响IABP应用的因素。在中国急性心肌梗死（CAMI）注册研究中，一项全国性、多中心（107家医院）的前瞻性研究，于2013年1月1日至2014年9月30日连续纳入26592例急性心肌梗死患者。在排除30例因重要数据缺失的病例后，对26562例病例进行分析。分析IABP的应用状况并进行多因素logistic回归分析以确定与IABP应用相关的因素。共有785例（3.0%）急性心肌梗死患者接受IABP植入，其中381例（49.9%）患者属于在直接经皮冠状动脉介入治疗前预防性应用IABP，6例（0.8%）患者合并机械性并发症。有118例（15.0%）心源性休克患者接受IABP植入，占所有心源性休克患者的12.0%（118/984）。多因素logistic回归分析显示，决定IABP置入的临床独立因素包括血脂异常（2.858，95% 1.397 - 5.846，0.004）、左心室射血分数（0.977，95% 0.961 - 0.994，0.009）、多巴胺的使用（2.817，95% 1.495 - 5.308，0.001）、左主干病变（2.817，95% 1.495 - 5.308，0.001）、GRACE评分（1.006，95% 1.000 - 1.011，0.034）、接受直接经皮冠状动脉介入治疗（4.508，95% 1.673 - 12.146，0.003）、三级医院（2.562，95% 1.498 - 4.384，0.001）以及患者的高等教育程度（2.183，95% 1.056 - 4.509，0.016）。在中国接受IABP植入的急性心肌梗死患者中，近一半的IABP应用是在直接经皮冠状动脉介入治疗前预防性植入。只有少数合并心源性休克的患者接受IABP置入。临床状况、医院级别、教育程度影响急性心肌梗死患者IABP置入的决策。临床试验注册 美国国立卫生研究院，NCT018746 。
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