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心源性休克血运重建的趋势、结局和预测因素。

Trends, Outcomes, and Predictors of Revascularization in Cardiogenic Shock.

机构信息

Department of Medicine, West Virginia University, Morgantown, West Virginia.

Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia.

出版信息

Am J Cardiol. 2020 Feb 1;125(3):328-335. doi: 10.1016/j.amjcard.2019.10.040. Epub 2019 Nov 6.

Abstract

Cardiogenic shock (CS) carries high mortality and morbidity. Early revascularization is an important strategy in management of these patients. We sought to determine the outcomes and predictors of revascularization among patients with CS. Patients with CS and acute myocardial infarction were identified using the National Inpatient Sample (NIS) data from January 2002 to December 2014 using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Subsequently, patients who underwent revascularization were then selected. A total of 118,618 patients with CS were identified. Out of these, about 55,735 (47%) patients underwent revascularization. Mean age of patients who underwent revascularization was lower when compared with patients not who underwent revascularization (66.40 vs 72.24 years, p < 0.01). Patients who underwent revascularization had lower mortality when compared with patients not who underwent revascularization (25.1% vs 52.2%, p < 0.01). Extracorporeal membrane oxygenation and mechanical circulatory support devices were often utilized more in patients who underwent revascularization. Overall, we found modest increased trend of revascularization over our study years with decline in mortality. Female gender, weekend admission, drug abuse, pulmonary hypertension, anemia, renal failure, neurological disorders, malignancy were associated with lower odds of revascularization. In conclusion, in this large nationally represented US population sample of CS patients, we found revascularization rate of about 47% with improvement in overall mortality over our study years.

摘要

心原性休克(CS)的死亡率和发病率很高。早期血运重建是这类患者治疗的重要策略。我们旨在确定 CS 患者血运重建的结局和预测因素。使用国际疾病分类,第 9 修订版,临床修正(ICD-9-CM)代码,我们从 2002 年 1 月至 2014 年 12 月从国家住院患者样本(NIS)数据中确定了 CS 和急性心肌梗死患者。随后,选择了接受血运重建的患者。确定了 118618 例 CS 患者。其中,约有 55735 例(47%)接受了血运重建。与未接受血运重建的患者相比,接受血运重建的患者的平均年龄较低(66.40 岁 vs 72.24 岁,p<0.01)。与未接受血运重建的患者相比,接受血运重建的患者死亡率较低(25.1% vs 52.2%,p<0.01)。接受血运重建的患者更常使用体外膜氧合和机械循环支持设备。总体而言,在我们的研究年限内,血运重建的趋势适度增加,死亡率下降。女性、周末入院、药物滥用、肺动脉高压、贫血、肾衰竭、神经系统疾病、恶性肿瘤与血运重建的可能性降低有关。总之,在我们这项具有全国代表性的 CS 患者美国人群样本研究中,我们发现血运重建率约为 47%,在我们的研究年限内整体死亡率有所改善。

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