Department of Cardiology, Justus-Liebig University of Giessen, Germany.
Department of Cardiology, Kerckhoff Klinik Bad Nauheim, Germany.
Eur Heart J Acute Cardiovasc Care. 2020 Mar;9(2):120-127. doi: 10.1177/2048872618822460. Epub 2019 Jan 8.
There is a large body of literature on acute myocardial infarction complicated by cardiogenic shock. However, very little is known about patients who are initially haemodynamically stable and develop cardiogenic shock during percutaneous coronary intervention.
A total of 47,407 consecutive patients were prospectively enrolled in the PCI Registry of the Euro Heart Survey Programme. We analysed interventions with peri-procedural complications that were classified as 'shock induced by procedure' on the case report form. Clinical and procedural characteristics as well as hospital outcomes of haemodynamically stable patients who developed cardiogenic shock during percutaneous coronary intervention were evaluated. Patients with haemodynamic instability at presentation prior to intervention were excluded.
A total of 68 patients (0.2%) developed cardiogenic shock as a complication of percutaneous coronary intervention. The majority of cases comprised acute coronary syndrome (60.3%) with complex lesions (93.1%). Most patients had multi-vessel disease (82.1%) and an ejection fraction less than 40% (58.1%). In the multivariate analysis, left main disease (odds ratio (OR) 9.51), ST-segment elevation myocardial infarction (OR 5.31) and multi-vessel disease without left main involvement (OR 3.32) were the strongest independent predictors of peri-procedural cardiogenic shock. Among these patients procedural success was low (66.1%) and in-hospital mortality was very high (39.7%).
In this real-world registry the rate of haemodynamically stable patients who developed cardiogenic shock during percutaneous coronary intervention was very low. Patients at a priori high risk were more likely to be affected by this complication. The in-hospital mortality rate of these patients was very high.
有大量关于并发心原性休克的急性心肌梗死的文献。然而，对于最初血流动力学稳定但在经皮冠状动脉介入治疗期间发生心原性休克的患者，知之甚少。
共有 47407 例连续患者前瞻性纳入 Euro Heart Survey 计划的 PCI 登记处。我们分析了病例报告表上被归类为“程序引起的休克”的围手术期并发症的介入治疗。评估了在经皮冠状动脉介入治疗期间发生心原性休克的血流动力学稳定患者的临床和程序特征以及住院结局。排除了在介入前存在血流动力学不稳定的患者。
共有 68 例患者（0.2%）发生经皮冠状动脉介入治疗的并发症心原性休克。大多数病例为急性冠状动脉综合征（60.3%）伴复杂病变（93.1%）。大多数患者有多血管疾病（82.1%）和射血分数小于 40%（58.1%）。多变量分析显示，左主干疾病（优势比（OR）9.51）、ST 段抬高型心肌梗死（OR 5.31）和无左主干受累的多血管疾病（OR 3.32）是围手术期心原性休克的最强独立预测因素。在这些患者中，程序成功率低（66.1%），住院死亡率非常高（39.7%）。
在这个真实世界的登记处，在经皮冠状动脉介入治疗期间血流动力学稳定但发生心原性休克的患者的比例非常低。预先处于高风险的患者更有可能发生这种并发症。这些患者的住院死亡率非常高。
