Sakamoto Kazuo, Matoba Tetsuya, Mohri Masahiro, Ueki Yasushi, Tsujita Yasuyuki, Yamasaki Masao, Tanaka Nobuhiro, Hokama Yohei, Fukutomi Motoki, Hashiba Katsutaka, Fukuhara Rei, Suwa Satoru, Matsuura Hirohide, Tachibana Eizo, Yonemoto Naohiro, Nagao Ken
JCS Shock Registry Scientific Committee, Tokyo, Japan.
Department of Cardiovascular Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Heart Vessels. 2019 Aug;34(8):1241-1249. doi: 10.1007/s00380-019-01354-9. Epub 2019 Feb 4.
Cardiogenic shock frequently leads to death even with intensive treatment. Although the leading cause of cardiogenic shock is acute coronary syndrome (ACS), the clinical characteristics and the prognosis of ACS with cardiogenic shock in the present era still remain to be elucidated. We analyzed clinical characteristics and predictors of 30-day mortality in ACS with cardiogenic shock in Japan. The Japanese Circulation Society Cardiovascular Shock registry was a prospective, observational, multicenter, cohort study. Between May 2012 and June 2014, 495 ACS patients with cardiogenic shock were analyzed. The primary endpoint was 30-day all-cause mortality. The median [interquartile range; IQR] age was 71.0 [63.0, 80.0] years. The median [IQR] value of systolic blood pressure (SBP) and heart rate were 75.0 [50.0, 86.5] mm Hg and 65.0 [38.0, 98.0] bpm, respectively. Multivariable analysis showed an odds ratio (OR) of 4.76 (confidence intervals; CI 1.97-11.5, p < 0.001) in the lowest SBP category (< 50 mm Hg) for SBP ≥ 90 mm Hg. Moreover, age per 10 years increase (OR 1.38, CI 1.18-1.61, p = 0.002), deep coma (OR 3.49, CI 1.94-6.34, p < 0.001), congestive heart failure (OR 3.81, CI 2.04-7.59, p < 0.001) and left main trunk disease (LMTD) (OR 2.81, CI 1.55-5.10, p < 0.001) were independent predictors. Severe hypotension, older age, deep coma, congestive heart failure, and LMTD were independent unfavorable factors in ACS complicated by cardiogenic shock in Japan. A prompt assessment of high-risk patients referring to those predictors in emergency room could lead to appropriate treatment without delay.
即使经过强化治疗，心源性休克仍常导致死亡。虽然心源性休克的主要原因是急性冠状动脉综合征（ACS），但当代ACS合并心源性休克的临床特征和预后仍有待阐明。我们分析了日本ACS合并心源性休克患者的临床特征及30天死亡率的预测因素。日本循环学会心血管休克注册研究是一项前瞻性、观察性、多中心队列研究。在2012年5月至2014年6月期间，对495例ACS合并心源性休克患者进行了分析。主要终点是30天全因死亡率。年龄中位数[四分位间距；IQR]为71.0[63.0，80.0]岁。收缩压（SBP）和心率的中位数[IQR]值分别为75.0[50.0，86.5]mmHg和65.0[38.0，98.0]次/分钟。多变量分析显示，SBP≥90mmHg时，最低SBP类别（<50mmHg）的比值比（OR）为4.76（置信区间；CI 1.97 - 11.5，p<0.001）。此外，年龄每增加10岁（OR 1.38，CI 1.18 - 1.61，p = 0.002）、深度昏迷（OR 3.49，CI 1.94 - 6.34，p<0.001）、充血性心力衰竭（OR 3.81，CI 2.04 - 7.59，p<0.001）和左主干病变（LMTD）（OR 2.81，CI 1.55 - 5.10，p<0.001）是独立的预测因素。严重低血压、老年、深度昏迷、充血性心力衰竭和LMTD是日本ACS合并心源性休克的独立不良因素。在急诊室参考这些预测因素对高危患者进行及时评估，可立即进行适当治疗。
