Noaman Samer, Andrianopoulos Nick, Brennan Angela L, Dinh Diem, Reid Christopher, Stub Dion, Biswas Sinjini, Clark David, Shaw James, Ajani Andrew, Freeman Melanie, Yip Thomas, Oqueli Ernesto, Walton Antony, Duffy Stephen J, Chan William
Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.
Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
Catheter Cardiovasc Interv. 2020 Sep 1;96(3):E257-E267. doi: 10.1002/ccd.28759. Epub 2020 Feb 3.
We aimed to assess the outcomes of cardiogenic shock (CS) complicating acute coronary syndromes (ACS).
CS remains the leading cause of mortality in patients presenting with ACS despite advances in care.
We studied 13,184 patients undergoing percutaneous coronary intervention (PCI) for all subtypes of ACS enrolled prospectively in a large multicentre Australian registry (Melbourne Interventional Group registry) from 2005 to 2013. All-cause mortality was obtained via linkage to the National Death Index. Patients were divided into those with and those without CS.
Compared to the non-CS group (n = 12,548, 95.2%), the CS group (n = 636, 4.8%) had a higher proportion of out-of-hospital cardiac arrest (OHCA) (31.1 vs. 2.2%) and ST-elevation myocardial infarction (STEMI) presentation (89 vs. 34%), both p < .01. Patients in the CS group had higher rates of in-hospital (40.4 vs. 1.2%) and 30-day (41 vs. 1.7%) mortality compared to the non-CS group. Long-term mortality over a median follow-up of 4.2 years was higher in the CS group (50.6 vs. 13.8%), p < .001. Trends of in-hospital and 30-day mortality rates of CS complicating ACS were relatively stable from 2005 to 2013. Predictors of long-term NDI-linked mortality within the CS group include severe left ventricular systolic dysfunction (HR 3.0), glomerular filtration rate (GFR) <30 (HR 2.56), GFR 30-59 (HR 1.94), OHCA (HR 1.46), diabetes (HR 1.44), and age (HR 1.02), all p < .05.
Rates of CS-related mortality complicating ACS have remained very high and steady over nearly a decade despite progress in STEMI systems of care, PCI techniques, and medical therapy.
我们旨在评估并发急性冠脉综合征（ACS）的心源性休克（CS）的预后情况。
尽管治疗取得了进展，但CS仍然是ACS患者死亡的主要原因。
我们研究了2005年至2013年在澳大利亚一个大型多中心注册研究（墨尔本介入组注册研究）中前瞻性纳入的13184例因所有亚型ACS接受经皮冠状动脉介入治疗（PCI）的患者。通过与国家死亡索引联动获取全因死亡率。患者被分为有CS和无CS两组。
与非CS组（n = 12548，95.2%）相比，CS组（n = 636，4.8%）院外心脏骤停（OHCA）的比例更高（31.1%对2.2%），ST段抬高型心肌梗死（STEMI）表现的比例也更高（89%对34%），两者p均<0.01。与非CS组相比，CS组患者的院内死亡率（40.4%对1.2%）和30天死亡率（41%对1.7%）更高。在中位随访4.2年期间，CS组的长期死亡率更高（50.6%对13.8%），p<0.001。2005年至2013年，并发ACS的CS的院内和30天死亡率趋势相对稳定。CS组内与国家死亡索引相关的长期死亡率的预测因素包括严重左心室收缩功能障碍（HR 3.0）、肾小球滤过率（GFR）<30（HR 2.56）、GFR 30 - 59（HR 1.94）、OHCA（HR 1.46）、糖尿病（HR 1.44）和年龄（HR 1.02），所有p均<0.05。
尽管在STEMI治疗体系、PCI技术和药物治疗方面取得了进展，但近十年来并发ACS的CS相关死亡率一直非常高且稳定。
