美国急性心肌梗死合并心源性休克患者院内死亡时间的流行病学趋势
Epidemiological Trends in the Timing of In-Hospital Death in Acute Myocardial Infarction-Cardiogenic Shock in the United States.
作者信息
Vallabhajosyula Saraschandra, Dunlay Shannon M, Bell Malcolm R, Miller P Elliott, Cheungpasitporn Wisit, Sundaragiri Pranathi R, Kashani Kianoush, Gersh Bernard J, Jaffe Allan S, Holmes David R, Barsness Gregory W
机构信息
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
出版信息
J Clin Med. 2020 Jul 3;9(7):2094. doi: 10.3390/jcm9072094.
BACKGROUND
There are limited data on the epidemiology and timing of in-hospital death (IHD) in patients with acute myocardial infarction-cardiogenic shock (AMI-CS).
METHODS
Adult admissions with AMI-CS with IHDs were identified using the National Inpatient Sample (2000-2016) and were classified as early (≤2 days), mid-term (3-7 days), and late (>7 days). Inter-hospital transfers and those with do-not-resuscitate statuses were excluded. The outcomes of interest included the epidemiology, temporal trends and predictors for IHD timing.
RESULTS
IHD was noted in 113,349 AMI-CS admissions (median time to IHD 3 (interquartile range 1-7) days), with early, mid-term and late IHD in 44%, 32% and 24%, respectively. Compared to the mid-term and late groups, the early IHD group had higher rates of ST-segment-elevation AMI-CS (74%, 63%, 60%) and cardiac arrest (37%, 33%, 29%), but lower rates of acute organ failure (68%, 79%, 89%), use of coronary angiography (45%, 56%, 67%), percutaneous coronary intervention (33%, 36%, 42%), and mechanical circulatory support (31%, 39%, 50%) (all < 0.001). There was a temporal increase in the early (adjusted odds ratio (aOR) for 2016 vs. 2000 2.50 (95% confidence interval (CI) 2.22-2.78)) and a decrease in mid-term (aOR 0.75 (95% CI 0.71-0.79)) and late (aOR 0.34 (95% CI 0.31-0.37)) IHD. ST-segment-elevation AMI-CS and cardiac arrest were associated with the increased risk of early IHD, whereas advanced comorbidity and acute organ failure were associated with late IHD.
CONCLUSIONS
Early IHD after AMI-CS has increased between 2000 and 2016. The populations with early vs. late IHD were systematically different.
背景
关于急性心肌梗死合并心源性休克（AMI-CS）患者的院内死亡（IHD）流行病学及时间规律的数据有限。
方法
利用国家住院患者样本（2000 - 2016年）确定患有AMI-CS且发生IHD的成年住院患者，并分为早期（≤2天）、中期（3 - 7天）和晚期（>7天）。排除院间转运患者及有“不要复苏”状态的患者。感兴趣的结局包括IHD的流行病学、时间趋势及IHD时间的预测因素。
结果
在113,349例AMI-CS住院患者中发现了IHD（至IHD的中位时间为3天（四分位间距1 - 7天）），早期、中期和晚期IHD分别占44%、32%和24%。与中期和晚期组相比，早期IHD组ST段抬高型AMI-CS的发生率更高（分别为74%、63%、60%）以及心脏骤停发生率更高（分别为37%、33%、29%），但急性器官衰竭发生率更低（分别为68%、79%、89%），冠状动脉造影使用率更低（分别为45%、56%、67%），经皮冠状动脉介入治疗率更低（分别为33%、36%、42%）以及机械循环支持使用率更低（分别为31%、39%、50%）（均P<0.001）。早期IHD呈时间上的增加趋势（2016年与2000年相比，校正比值比（aOR）为2.50（95%置信区间（CI）2.22 - 2.78）），中期（aOR 0.75（95%CI 0.71 - 0.79））和晚期（aOR 0.34（95%CI 0.31 - 0.37））IHD呈下降趋势。ST段抬高型AMI-CS和心脏骤停与早期IHD风险增加相关，而晚期合并症和急性器官衰竭与晚期IHD相关。
结论
2000年至2016年间，AMI-CS后的早期IHD有所增加。早期与晚期IHD的人群存在系统性差异。
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