Bendz Bjørn, Gude Einar, Ragnarsson Asgrimur, Endresen Knut, Aaberge Lars, Geiran Odd, Simonsen Svein
Department of Cardiology.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Scand Cardiovasc J. 2019 Dec;53(6):337-341. doi: 10.1080/14017431.2019.1657938. Epub 2019 Sep 3.
Coronary revascularisation and intra-aortic balloon pump (IABP) has been considered the gold standard treatment of acute coronary syndrome with cardiogenic shock, recently challenged by the SHOCK II study. The aim of this non-randomised study was to investigate the long term prognosis after immediate IABP supported angiography, in patients with acute chest pain and cardiogenic shock, treated with percutaneous coronary intervention (PCI), cardiac surgery or optimal medical treatment. We assessed data from 281 consecutive patients admitted to our department from 2004 to 2010. Mean (±SD) age was 63.8 ± 11.5 (range 30-84) years with a follow-up of 5.6 ± 4.4 (0-12.7) years. Acute myocardial infarction was the primary diagnosis in 93% of the patients, 4% presented with unstable angina pectoris and 3% cardiomyopathy or arrhythmias of non-ischemic aetiology. Systolic blood pressure at admittance was 85 ± 18 mmHg and diastolic 55 ± 18 mmHg. Thirty day, one- and five-year survival was 71.2%, 67.3% and 57.7%, respectively. PCI was performed immediately in 70%, surgery was done in 17%, and 13% were not eligible for any revascularisation. Independent variables predicting mortality were medical treatment vs revascularisation, out-of-hospital cardiac arrest, and advanced age. Three serious non-fatal complications occurred due to IABP treatment, i.e. 0.001 per treatment day. We report the use of IABP in patients with acute chest pain admitted for angiography. Long-term survival is acceptable and discriminating factors were no revascularisation, out-of-hospital cardiac arrest and age. IABP was safe and feasible and the complication rate was low.
冠状动脉血运重建和主动脉内球囊反搏（IABP）一直被视为治疗急性冠状动脉综合征伴心源性休克的金标准疗法，不过最近受到了SHOCK II研究的挑战。这项非随机研究的目的是调查在接受经皮冠状动脉介入治疗（PCI）、心脏手术或最佳药物治疗的急性胸痛伴心源性休克患者中，在IABP支持下立即进行血管造影后的长期预后情况。我们评估了2004年至2010年连续入住我科的281例患者的数据。平均（±标准差）年龄为63.8±11.5（范围30 - 84）岁，随访时间为5.6±4.4（0 - 12.7）年。93%的患者主要诊断为急性心肌梗死，4%表现为不稳定型心绞痛，3%为非缺血性病因的心肌病或心律失常。入院时收缩压为85±18 mmHg，舒张压为55±18 mmHg。30天、1年和5年生存率分别为71.2%、67.3%和57.7%。70%的患者立即进行了PCI，17%进行了手术，13%不符合任何血运重建条件。预测死亡率的独立变量包括药物治疗与血运重建、院外心脏骤停和高龄。IABP治疗导致3例严重非致命并发症，即每治疗日0.001例。我们报告了IABP在因血管造影入院的急性胸痛患者中的应用情况。长期生存率尚可，判别因素为未进行血运重建、院外心脏骤停和年龄。IABP安全可行，并发症发生率低。
