Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut.
Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut.
Am J Cardiol. 2019 Mar 1;123(5):750-756. doi: 10.1016/j.amjcard.2018.11.041. Epub 2018 Dec 4.
Predictors of survival in cardiogenic shock (CS) treated with intra-aortic balloon pump (IABP) are not clearly understood. In this retrospective study, we sought to evaluate patient characteristics and impact of timing of IABP in treatment of CS. Patients presenting to the Yale New Haven Hospital in CS who received IABP between February 2013 and April 2017 were included in the study. We assessed baseline characteristics and clinical predictors of 30-day mortality. Hundred ninety-three (n = 193) patients were included in this study. Mean age was 68.8 ± 14.5 years. Thirty percent (30%) were women, 38% had cardiac arrest, and left ventricular ejection fraction was 33.7 ± 14.9%. Overall 30-day mortality was 36%. Thirty-day mortality was 24% when IABP was placed within less than 1 hour of onset of CS versus 49% when implanted ≥1 hour after recognition of CS (p = 0.001). Mortality was 18%, 21%, 36%, and 74% for patient requiring 0, 1, 2, and 3 or more inotropes after IABP placement (p < 0.001). In multivariate analysis, advancing age, cardiac arrest on presentation, time to IABP implantation, and number of inotropes needed after IABP implantation predicted 30-day mortality. In the 193 patients, 134 (69.4%) presented with CS from ACS and 59 (30.6%) with CS from non-ACS-related causes. No difference in mortality was noted between the ACS and non-ACS groups 34.3% versus 40.7% (p = 0.39). In conclusion, early use of IABP in CS was associated with significant improvement in 30-day mortality regardless of the etiology of CS. Continued need for significant inotropic support after IABP is associated with worse prognosis and maybe used as an indicator for need to escalate to higher levels of support.
在接受主动脉内球囊泵（IABP）治疗的心源性休克（CS）患者中，生存预测因素尚不清楚。在这项回顾性研究中，我们旨在评估患者特征和 IABP 治疗 CS 的时机的影响。本研究纳入了 2013 年 2 月至 2017 年 4 月期间在耶鲁纽黑文医院因 CS 接受 IABP 治疗的患者。我们评估了 30 天死亡率的基线特征和临床预测因素。本研究共纳入 193 例患者。平均年龄为 68.8 ± 14.5 岁。30%为女性，38%发生心搏骤停，左心室射血分数为 33.7 ± 14.9%。总体 30 天死亡率为 36%。在心源性休克发作后 1 小时内植入 IABP 的患者 30 天死亡率为 24%，而在心源性休克发作后 1 小时以上植入 IABP 的患者 30 天死亡率为 49%（p=0.001）。在 IABP 植入后需要 0、1、2 和 3 种或更多正性肌力药物的患者中，30 天死亡率分别为 18%、21%、36%和 74%（p<0.001）。多变量分析显示，年龄增长、入院时发生心搏骤停、IABP 植入时间以及 IABP 植入后需要的正性肌力药物数量均预测 30 天死亡率。在 193 例患者中，134 例（69.4%）因 ACS 导致 CS，59 例（30.6%）因非 ACS 相关原因导致 CS。ACS 组和非 ACS 组之间的死亡率无差异（34.3%比 40.7%）（p=0.39）。结论：无论 CS 的病因如何，CS 患者早期使用 IABP 均与 30 天死亡率的显著改善相关。IABP 后继续需要大量正性肌力支持与预后较差相关，可能作为需要升级到更高水平支持的指标。
