3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Centre for Heart Disease in Zabrze, Zabrze, Poland.
3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Centre for Heart Disease in Zabrze, Zabrze, Poland; Department of Cardiology, University Hospital in Opole, Faculty of Natural Sciences and Technology, University of Opole, Opole, Poland.
JACC Cardiovasc Interv. 2018 Sep 24;11(18):1885-1893. doi: 10.1016/j.jcin.2018.07.030.
The authors sought to compare outcomes of patients with myocardial infarction and cardiogenic shock (CS) treated with percutaneous coronary intervention (PCI) with or without intra-aortic balloon pump (IABP) support according to final epicardial flow in the infarct-related artery.
A routine use of IABP is contraindicated in patients with myocardial infarction and CS. There are no data regarding the subpopulation of patients who may benefit from such support besides patients with mechanical complications of myocardial infarction.
Prospective nationwide registry data of patients with myocardial infarction and CS treated with PCI between 2003 and 2014 were analyzed. Patients were initially stratified into 2 groups according to final infarct-related artery Thrombolysis In Myocardial Infarction (TIMI) flow grade after PCI: those with successful primary PCI (TIMI flow grades 2 or 3) and those with unsuccessful primary PCI (TIMI flow grades 0 or 1). Outcomes of patients with or without IABP treatment in each group were analyzed and compared.
In the unsuccessful PCI group, patients in whom IABP was applied had lower in-hospital, 30-day, and 12-month mortality. IABP support in this group of patients was an independent predictor of lower 30-day mortality (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.59 to 0.89; p = 0.002). Conversely, in patients with successful PCI, IABP was an independent predictor of higher 30-day mortality (HR: 1.18; 95% CI: 1.08 to 1.30; p = 0.0004).
IABP is associated with a lower risk of 30-day mortality in patients with myocardial infarction complicated by CS, in whom primary PCI was unsuccessful.
作者旨在比较经皮冠状动脉介入治疗（PCI）联合与不联合主动脉内球囊反搏（IABP）治疗伴心原性休克（CS）的心肌梗死患者的结局，这些患者根据梗死相关动脉的最终心外膜血流进行分组。
在伴 CS 的心肌梗死患者中，IABP 的常规应用是禁忌的。除了伴机械性心肌梗死并发症的患者外，尚无关于此类支持可能获益的亚组患者的数据。
分析了 2003 年至 2014 年期间接受 PCI 治疗的伴 CS 的心肌梗死患者的前瞻性全国登记数据。患者最初根据 PCI 后梗死相关动脉的血流分级（Thrombolysis In Myocardial Infarction，TIMI）分为 2 组：初次 PCI 成功组（TIMI 血流分级 2 或 3 级）和初次 PCI 失败组（TIMI 血流分级 0 或 1 级）。分析和比较了每组患者接受和不接受 IABP 治疗的结局。
在初次 PCI 失败组中，应用 IABP 的患者院内、30 天和 12 个月死亡率更低。该组患者中 IABP 支持是 30 天死亡率降低的独立预测因素（风险比 [HR]：0.72；95%置信区间 [CI]：0.59 至 0.89；p = 0.002）。相反，在初次 PCI 成功的患者中，IABP 是 30 天死亡率升高的独立预测因素（HR：1.18；95% CI：1.08 至 1.30；p = 0.0004）。
在初次 PCI 失败的伴 CS 的心肌梗死患者中，IABP 与 30 天死亡率降低相关。
