Singh Prabhjot, Lima Fabio V, Parikh Puja, Zhu Chencan, Lawson William, Mani Anil, Jeremias Allen, Yang Jie, Gruberg Luis
From Stony Brook University, Stony Brook, NY, United States of America.
Brown University, Providence, RI, United States of America.
Cardiovasc Revasc Med. 2018 Dec;19(8):923-928. doi: 10.1016/j.carrev.2018.10.013. Epub 2018 Oct 15.
Patient presenting with ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS) have extremely high mortality rates.
We sought to assess the impact of prior revascularization by either coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI) on the in-hospital and 12-month outcomes and compare them with revascularization-naïve patients.
Between 1/2010 and 5/2017, a total of 241 consecutive patients were admitted to our institution with STEMI and CS as defined by New York State Percutaneous Coronary Interventions Reporting System (PCIRS) and underwent primary PCI. Baseline clinical, angiographic and procedural characteristics, as well as in-hospital outcomes were prospectively collected among all patients undergoing primary PCI as part of the New York State PCIRS data collection. Patients with a history of prior bypass graft surgery were older and had a history of heart failure, hypertension, dyslipidemia, and diabetes. The left anterior descending coronary artery was usually the culprit vessel in post PCI and revascularization naïve patients, whereas it was a vein graft in patients with a prior history of surgical bypass. In-hospital mortality rates were different in the three groups and there was no significant difference in major adverse cardiac and cerebrovascular events rates among the three groups (p = 0.87). Notably, revascularization-naïve patients had higher rates of major bleeding complications (p = 0.006). By multivariable analysis, only age (OR 1.03; CI = 1.0-1.06), a prior history of congestive heart failure (OR 4.36, CI = 1.04-18.38) and dyslipidemia (OR 0.32 CI = 0.15-0.64) were independent predictors of 12-month mortality. Prior revascularization had no impact on rates of stroke, death or MACCE.
Patients with acute STEMI and CS had similar in-hospital and one year mortality, stroke or major adverse cardiac and cerebrovascular events rates irrespective of their prior revascularization status.
患有ST段抬高型心肌梗死（STEMI）并伴有心源性休克（CS）的患者死亡率极高。
我们旨在评估既往通过冠状动脉旁路移植术（CABG）或经皮冠状动脉介入治疗（PCI）进行血运重建对住院期间及12个月预后的影响，并将其与未进行血运重建的患者进行比较。
在2010年1月至2017年5月期间，共有241例连续入院的患者符合纽约州经皮冠状动脉介入治疗报告系统（PCIRS）定义的STEMI和CS，并接受了直接PCI。作为纽约州PCIRS数据收集的一部分，对所有接受直接PCI的患者前瞻性收集基线临床、血管造影和手术特征以及住院期间的预后情况。有既往旁路移植手术史的患者年龄较大，并有心力衰竭、高血压、血脂异常和糖尿病病史。在接受PCI后和未进行血运重建的患者中，左前降支冠状动脉通常是罪犯血管，而在有外科旁路手术史的患者中则是静脉移植物。三组患者的住院死亡率不同，三组患者的主要不良心脑血管事件发生率无显著差异（p = 0.87）。值得注意的是，未进行血运重建的患者主要出血并发症发生率较高（p = 0.006）。通过多变量分析，只有年龄（OR 1.03；CI = 1.0 - 1.06）、既往充血性心力衰竭病史（OR 4.36，CI = 1.04 - 18.38）和血脂异常（OR 0.32，CI = 0.15 - 0.64）是12个月死亡率的独立预测因素。既往血运重建对卒中、死亡或主要不良心脑血管事件发生率没有影响。
急性STEMI和CS患者无论其既往血运重建状态如何，住院期间及1年的死亡率、卒中或主要不良心脑血管事件发生率均相似。
