Josiassen Jakob, Helgestad Ole Kl, Møller Jacob E, Holmvang Lene, Jensen Lisette O, Udesen Nanna Lj, Ravn Hanne B, Hassager Christian
Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark.
Department of Cardiology, Odense University Hospital, Denmark.
Eur Heart J Acute Cardiovasc Care. 2021 Mar 5;10(1):25–32. doi: 10.1177/2048872620911848. Epub 2020 May 18.
As existing results are diverging, and the patient population has changed significantly, this study sought to investigate the prognostic importance of the culprit lesion location in patients with cardiogenic shock due to myocardial infarction (AMICS), in a contemporary and unselected patient population.
From the recruitment area of two tertiary heart centres in Denmark, covering 3.9 million citizens corresponding to two-thirds of the Danish population, all AMICS patients in the period of 2010-2017 were individually identified and validated through patient records.
A total of 1716 patients with AMICS were identified. Immediate revascularization was performed in 1482 patients (86%). Among these, a culprit lesion in the left main coronary artery (LM) was associated with the highest 30-day mortality rate (66%), <0.0001, which persisted after multivariable adjustment for variables known to be associated with mortality in AMICS, including age, gender, heart rate, lactate, diabetes, stroke and out-of-hospital cardiac arrest, =0.002. A culprit lesion in the remaining coronary arteries had comparable and lower 30-day mortality (43-48%), =0.39. Patients with multivessel disease had comparable prognoses irrespective of whether a culprit-only or multivessel percutaneous coronary intervention strategy was used (=0.80), and whether partial or complete revascularization was achieved (=0.24).
Among AMICS patients undergoing revascularization, a LM culprit lesion was associated with the highest short-term mortality, whereas patients with a culprit lesion in the remaining coronary arteries had comparable and lower mortality rates. Multivessel disease patients had similar prognoses irrespective of percutaneous coronary intervention approach and whether partial or complete revascularization was achieved.
由于现有研究结果存在分歧，且患者群体已发生显著变化，本研究旨在调查在当代未经过筛选的心肌梗死所致心源性休克（AMICS）患者中，罪犯病变部位的预后重要性。
从丹麦两个三级心脏中心的招募区域，涵盖390万公民，相当于丹麦人口的三分之二，通过患者记录对2010 - 2017年期间所有AMICS患者进行逐一识别和验证。
共识别出1716例AMICS患者。1482例患者（86%）接受了即刻血运重建。其中，左主干冠状动脉（LM）罪犯病变与最高的30天死亡率相关（66%），<0.0001，在对已知与AMICS死亡率相关的变量（包括年龄、性别、心率、乳酸、糖尿病、中风和院外心脏骤停）进行多变量调整后，该相关性依然存在，P = 0.002。其余冠状动脉罪犯病变的30天死亡率相当且较低（43 - 48%），P = 0.39。多支血管病变患者无论采用仅针对罪犯病变还是多支血管经皮冠状动脉介入策略（P = 0.80），以及无论实现的是部分还是完全血运重建（P = 0.24），其预后相当。
在接受血运重建的AMICS患者中，LM罪犯病变与最高的短期死亡率相关，而其余冠状动脉罪犯病变患者的死亡率相当且较低。多支血管病变患者无论经皮冠状动脉介入方法如何以及是否实现部分或完全血运重建，其预后相似。
