Avtaar Singh Sanjeet Singh, Das De Sudeep, Nappi Francesco, Al-Adhami Ahmed, Hegazy Yasser, Dalzell Jonathan, Doshi Harikrishna, Sinclair Andrew, Curry Philip, Petrie Mark, Berry Colin, Al-Attar Nawwar
Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK.
Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Glasgow, UK.
J Thorac Dis. 2019 Feb;11(2):542-548. doi: 10.21037/jtd.2019.01.21.
There are 0.9 catheterization labs per 100,000 inhabitants in Scotland for percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI), which are much less accessible to patients in remote and rural areas. An uncommon but sinister sequalae following AMI is cardiogenic shock (CS) that could be refractory to inotropic support. CS complicates 5-15% of AMIs occurring in ST-segment elevation myocardial infarctions (STEMIs). Outcomes of CS are poor with mortalities of up to 90% reported in the literature in the absence of experienced care. We report our experience as the tertiary referral centre in Scotland for MCS and heart transplantation over 8 years.
A retrospective review of prospectively collected data was undertaken on all patients registered to the MCS service. The database was interrogated for patient demographics, type of mechanical circulatory support (MCS) and duration of MCS support, PCI-outcomes and survival to 30 days. A time-to-event analysis was performed using patient survival as the primary outcome measure.
Twenty-three patients (16 male, 7 females) were included. The median age of the patients as 50 years (range, 45-56 years). VA-ECMO was the initial MCS of choice in 17 (73.9%) patients with BIVAD for 4 (17.4%) patients and LVAD for 2 (8.7%) patients. Thirty-day mortality was 21.8% in this cohort, however survival to discharge was 52.2%. Eleven (47.8%) patients recovered without the need for any further support, however only 9 (81.8%) patients in this subgroup survived to discharge. Three (13.0%) patients received a durable LVAD. In this subgroup, one patient was transplanted whereas two patients died due to complications while on support. The median length of in-hospital MCS support was 4 days. Median in-hospital stay was 27 days. Long-term follow up of up to 8 years demonstrates a high mortality beyond 30-day up to the first 6-month post MCS support.
MCS usage in these patients carries a high mortality in the early post-implantation period. However, there is a significant benefit to patients who survive the initial bridging period to recovery or destination therapy.
在苏格兰，每10万居民仅有0.9个导管插入实验室用于急性心肌梗死（AMI）的经皮冠状动脉介入治疗（PCI），偏远和农村地区的患者很难使用到这些实验室。AMI后一种不常见但严重的后遗症是心源性休克（CS），可能对正性肌力支持无效。CS使5%-15%的ST段抬高型心肌梗死（STEMI）并发AMI。在缺乏经验丰富的护理的情况下，文献报道CS的死亡率高达90%，预后很差。我们报告了我们作为苏格兰MCS和心脏移植三级转诊中心8年来的经验。
对所有登记在MCS服务的患者前瞻性收集的数据进行回顾性分析。查询数据库以获取患者人口统计学信息、机械循环支持（MCS）类型和MCS支持持续时间、PCI结果及30天生存率。以患者生存作为主要结局指标进行事件发生时间分析。
纳入23例患者（16例男性，7例女性）。患者中位年龄为50岁（范围45-56岁）。17例（73.9%）患者最初选择VA-ECMO作为MCS，4例（17.4%）患者选择BIVAD，2例（8.7%）患者选择LVAD。该队列30天死亡率为21.8%，然而出院生存率为52.2%。11例（47.8%）患者康复，无需任何进一步支持，然而该亚组中只有9例（81.8%）患者存活至出院。3例（13.0%）患者接受了永久性LVAD。在该亚组中，1例患者接受了移植，而2例患者在支持期间因并发症死亡。住院期间MCS支持的中位时长为4天。中位住院时间为27天。长达8年的长期随访表明，在MCS支持后的前6个月内，30天后的死亡率很高。
这些患者使用MCS在植入后的早期死亡率很高。然而，对于在初始桥接期存活下来恢复或接受目标治疗的患者有显著益处。
