Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Département de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France.
EuroIntervention. 2018 Apr 6;13(18):e2160-e2168. doi: 10.4244/EIJ-D-17-01014.
The aim of the study was to identify independent correlates of survival in patients undergoing PCI for refractory cardiogenic shock due to myocardial infarction (RCS-MI) with the need for extracorporeal life support (ECLS).
This observational single tertiary centre study enrolled 106 consecutive patients (52.7±10.4 years) with ECLS placed before or after the PCI. Half of the patients had triple vessel disease and PCI was attempted whenever possible (74.5%). The 30-day mortality rate was 63.2%. Left main culprit vessel disease (19% of patients) (adj. HR [95% CI]: 2.31 [1.27-4.18], p=0.006) and sepsis-related organ failure assessment ≥13 (adj. HR 2.17 [1.25-3.75], p=0.005) were independently associated with 30-day mortality. The use of intra-aortic balloon pump (IABP) combined with ECLS was an independent protective factor (adj. HR 0.48 [0.28-0.80], p=0.006). Neither complete (p=0.66) nor successful (p=0.69) myocardial revascularisation was associated with 30-day survival.
RCS in MI patients often reveals a severe multivessel coronary artery disease with no impact of early percutaneous coronary revascularisation on clinical outcome. The survival advantage of IABP when combined with ECLS further suggests that achieving an early effective haemodynamic support should be the major goal in this young patient population.
本研究旨在确定因心肌梗死（RCS-MI）导致的心源性休克而需要体外生命支持（ECLS）的患者接受经皮冠状动脉介入治疗（PCI）后独立的生存相关因素。
本观察性、单中心、三级研究纳入了 106 例连续患者（52.7±10.4 岁），这些患者在接受 PCI 之前或之后均放置了 ECLS。一半的患者存在三支血管病变，并且只要有可能就会尝试 PCI（74.5%）。30 天死亡率为 63.2%。左主干罪犯血管病变（19%的患者）（校正 HR [95%CI]：2.31 [1.27-4.18]，p=0.006）和与脓毒症相关的器官衰竭评估≥13 分（校正 HR 2.17 [1.25-3.75]，p=0.005）与 30 天死亡率独立相关。使用主动脉内球囊泵（IABP）联合 ECLS 是一个独立的保护因素（校正 HR 0.48 [0.28-0.80]，p=0.006）。完全（p=0.66）或成功（p=0.69）的血运重建均与 30 天生存率无关。
MI 患者的心源性休克常伴有严重的多支冠状动脉疾病，早期经皮冠状动脉血运重建对临床结局无影响。IABP 与 ECLS 联合使用的生存优势进一步表明，在这一年轻患者群体中，实现早期有效的血液动力学支持应是主要目标。
