Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota.
Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, California.
JACC Cardiovasc Interv. 2020 May 25;13(10):1211-1219. doi: 10.1016/j.jcin.2020.04.004.
This study sought to compare the clinical characteristics and long-term outcomes of patients with ST-segment elevation myocardial infarction (STEMI) with and without cardiogenic shock (CS) or cardiac arrest (CA) before percutaneous coronary intervention (PCI).
Patients with STEMI complicated by CS or CA are underrepresented in STEMI registries.
Consecutive patients with STEMI or new left bundle branch block within 24 h of symptom onset were included in a regional STEMI program comprising a PCI center (Minneapolis Heart Institute at Abbott Northwestern Hospital), 11 hospitals <60 miles from PCI center (zone 1), and 19 hospitals 60 to 210 miles from PCI center (zone 2). No patients were excluded. Patients were stratified based on the presence (+) or absence (-) of CS or CA before PCI. Patients with CA were further classified based on initial rhythm. Primary outcomes were in-hospital and 5-year mortality.
Between March 2003 and December 2014, 4,511 STEMI patients were included in the regional program, including 398 (9%) with CS and 499 (11%) with CA. Hospital mortality was: CS+ and CA+, 44%; CS+ and CA-, 23%; CS- and CA+, 19%; and CS- and CA-, 2% (p < 0.001). The 5-year survival probability for CS+ and CA+ patients was 0.69 (95% confidence interval: 0.61 to 0.76) and 0.89 (95% confidence interval: 0.84 to 0.93), respectively (p < 0.01). Compared with patients with shockable rhythms, CA patients with nonshockable rhythms had significantly lower odds of survival at hospital discharge and at 5 years (both p < 0.001).
The combination of CS and CA significantly increases short-term mortality in patients with STEMI. After 5 years of follow-up, CS patients remained at high risk of fatal events, whereas the prognosis of CA patients was determined by initial rhythm at presentation.
本研究旨在比较经皮冠状动脉介入治疗（PCI）前合并心源性休克（CS）或心脏骤停（CA）与不合并 CS 或 CA 的 ST 段抬高型心肌梗死（STEMI）患者的临床特征和长期预后。
STEMI 登记研究中 STEMI 合并 CS 或 CA 的患者代表性不足。
连续纳入症状发作后 24 小时内发生 STEMI 或新发左束支传导阻滞的患者，这些患者来自一个包含 PCI 中心（明尼阿波利斯心脏研究所西北医院）的区域性 STEMI 项目，该 PCI 中心周边 11 家医院（距离 PCI 中心<60 英里，区域 1）和 19 家距离 PCI 中心 60-210 英里的医院（区域 2）。没有排除患者。根据 PCI 前是否存在 CS 或 CA 对患者进行分层。CA 患者进一步根据初始节律进行分类。主要结局是院内和 5 年死亡率。
2003 年 3 月至 2014 年 12 月，该区域性项目共纳入 4511 例 STEMI 患者，其中 398 例（9%）合并 CS，499 例（11%）合并 CA。住院死亡率为：CS+和 CA+，44%；CS+和 CA-，23%；CS-和 CA+，19%；CS-和 CA-，2%（p<0.001）。CS+和 CA+患者 5 年生存率分别为 0.69（95%置信区间：0.61 至 0.76）和 0.89（95%置信区间：0.84 至 0.93）（p<0.01）。与有可除颤节律的患者相比，有不可除颤节律的 CA 患者出院时和 5 年后的生存率明显较低（均 p<0.001）。
CS 和 CA 的联合显著增加了 STEMI 患者的短期死亡率。5 年随访后，CS 患者仍面临高死亡风险，而 CA 患者的预后则取决于发病时的初始节律。
