Department of Critical Care, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Européen Georges Pompidou (HEGP), Paris, France.
Faculty of Medicine, University Paris Descartes, Paris, France.
Eur J Heart Fail. 2020 Apr;22(4):664-672. doi: 10.1002/ejhf.1750. Epub 2020 Feb 20.
Few studies describe recent changes in the prevalence, management, and outcomes of cardiogenic shock (CS) patients complicating acute myocardial infarction (AMI) in the era of widespread use of invasive strategies. The aim of the present study was to analyse trends observed in CS complicating AMI over the past 10 years, focusing on the timing of CS occurrence (i.e. primary CS, CS on admission vs. secondary CS, CS developed subsequently during hospitalization).
Three nationwide French registries conducted and designed to evaluate AMI management and outcomes in 'real-life' practice included consecutive AMI patients (n = 9951) admitted to intensive cardiovascular care units (ICCUs) over a 1-month period, 5 years apart. The prevalence of CS complicating AMI decreased from 2005 to 2015: 5.9%, mean age 74.1 ± 12.7 in 2005; 4.0%, mean age 73.9 ± 12.7 in 2010, 2.8%, mean age 71.1 ± 15.0 in 2015 (P < 0.001). It decreased for both primary (1.8% to 1.0%) and secondary CS (4.1% to 1.8%). The profile of CS patients also changed over time with more patients presenting out-of-hospital cardiac arrest. In both primary and secondary CS, the use of percutaneous coronary intervention increased markedly over time, as did the use of mechanical ventilation and cardiac assist devices. Over the 10-year period, in-hospital mortality remained unchanged for both primary CS (41.8% to 37.8%) or secondary CS (57.3% to 58.8%). However, 1-year mortality decreased in patients with primary CS (from 60% to 37.8%, P = 0.038), and remained unchanged in patients developing secondary CS (from 64.5% to 69.1%, P = 0.731).
Cardiogenic shock complicating AMI has become less frequent but, if present, CS, and particularly secondary CS, carries a very high mortality, which has not substantially improved over the past 10 years, in spite of the more frequent use of invasive strategies.
在广泛应用有创策略的时代，很少有研究描述急性心肌梗死（AMI）并发心源性休克（CS）患者的患病率、治疗和结局的近期变化。本研究的目的是分析过去 10 年 AMI 并发 CS 的趋势，重点关注 CS 发生的时间（即原发性 CS、入院时 CS 与继发性 CS、住院期间随后发生的 CS）。
三个全国性的法国注册研究旨在评估“真实世界”实践中 AMI 的管理和结局，连续纳入了在心血管重症监护病房（ICCU）住院 1 个月的 AMI 患者（n=9951），每隔 5 年进行一次。AMI 并发 CS 的患病率从 2005 年至 2015 年下降：5.9%，平均年龄 74.1±12.7 岁（2005 年）；4.0%，平均年龄 73.9±12.7 岁（2010 年）；2.8%，平均年龄 71.1±15.0 岁（2015 年）（P<0.001）。原发性 CS（1.8%至 1.0%）和继发性 CS（4.1%至 1.8%）均有所下降。CS 患者的情况也随时间发生了变化，更多的患者出现院外心脏骤停。在原发性和继发性 CS 中，经皮冠状动脉介入治疗的使用率均显著增加，机械通气和心脏辅助设备的使用率也有所增加。在 10 年期间，原发性 CS（41.8%至 37.8%）或继发性 CS（57.3%至 58.8%）的住院死亡率保持不变。然而，原发性 CS 患者的 1 年死亡率下降（从 60%降至 37.8%，P=0.038），继发性 CS 患者的死亡率保持不变（从 64.5%降至 69.1%，P=0.731）。
AMI 并发 CS 的频率有所降低，但如果发生 CS，特别是继发性 CS，死亡率非常高，尽管有创策略的应用更加频繁，但过去 10 年来死亡率并没有显著改善。
