Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
EuroIntervention. 2018 Apr 6;13(18):e2152-e2159. doi: 10.4244/EIJ-D-17-00947.
Despite rising rates of cardiogenic shock (CS), data on trends and in-hospital outcomes of short-term non-durable mechanical circulatory support (MCS) are limited. Thus, we aimed to identify recent national trends in MCS utilisation in the USA, patient-level predictors of MCS use, and in-hospital outcomes in CS inclusive of extracorporeal membrane oxygenation (ECMO).
Hospitalisations of US adults with a discharge diagnosis of CS, from January 2004 to December 2014, in the National Inpatient Sample were included. Rates of MCS were stratified by device type and clinical presentation. Outcomes included in-hospital mortality, hospitalisation costs, and number of procedures. A total of 183,516 hospitalisations with CS (47,636 [25.9%] involving MCS) were included. MCS recipients were younger, less frequently female, received more procedures, had higher costs, and more frequently presented with MI (MCS vs. non-MCS: 71.6% vs. 42.9%; p<0.0001). Growth in CS hospitalisations (214.4%) outpaced annual MCS use (160.0%), with relative declines in intra-aortic balloon pump use starting in 2008. Right heart catheterisation rates for both groups remained low (MCS vs. non-MCS: 5.9% vs. 3.3%; p<0.0001). In-hospital mortality declined but remained high in both groups (MCS vs. non-MCS [2014]: 32.7% vs. 41.5%; p<0.0001).
In-hospital mortality for CS has declined but remains high. Rates of CS have outpaced MCS utilisation which remains uncommon in non-MI hospitalisations with shock. MCS is associated with utilisation of other procedures during hospitalisation.
尽管心源性休克（CS）的发生率不断上升，但有关短期非耐久性机械循环支持（MCS）趋势和院内结局的数据有限。因此，我们旨在确定美国近期 MCS 使用的全国趋势、MCS 使用的患者水平预测因素以及包括体外膜肺氧合（ECMO）在内的 CS 院内结局。
纳入了 2004 年 1 月至 2014 年 12 月期间国家住院患者样本中美国成年人因 CS 出院诊断的住院患者。根据设备类型和临床表现对 MCS 率进行分层。结局包括院内死亡率、住院费用和手术次数。共纳入 183516 例 CS 住院患者（47636 [25.9%] 例涉及 MCS）。MCS 接受者年龄更小，女性比例更低，接受的手术更多，费用更高，更常出现心肌梗死（MCS 与非 MCS：71.6%与 42.9%；p<0.0001）。CS 住院患者的增长率（214.4%）超过了 MCS 使用的年增长率（160.0%），自 2008 年以来，主动脉内球囊泵的使用相对减少。两组的右心导管检查率均较低（MCS 与非 MCS：5.9%与 3.3%；p<0.0001）。尽管两组的院内死亡率均有所下降，但仍居高不下（MCS 与非 MCS [2014 年]：32.7%与 41.5%；p<0.0001）。
CS 的院内死亡率虽有所下降，但仍居高不下。CS 的发生率超过了 MCS 的使用率，而非 MI 合并休克的住院患者中 MCS 仍不常见。MCS 与住院期间其他手术的使用相关。
