Vallabhajosyula Saraschandra, Dunlay Shannon M, Prasad Abhiram, Sangaralingham Lindsey R, Kashani Kianoush, Shah Nilay D, Jentzer Jacob C
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States; Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota, United States; Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States; Department of Health Services Research, Mayo Clinic, Rochester, Minnesota, United States.
Resuscitation. 2020 Oct;155:55-64. doi: 10.1016/j.resuscitation.2020.07.022. Epub 2020 Aug 2.
There are limited data on the outcomes of cardiogenic shock (CS) and cardiac arrest (CA) complicating ST-segment-elevation myocardial infarction (STEMI).
Adult (>18 years) STEMI admissions were identified using the National Inpatient Sample (2000-2017) and classified as CS + CA, CS only, CA only and no CS/CA. Outcomes of interest included temporal trends, in-hospital mortality, hospitalization costs, use of do-not-resuscitate (DNR) status and palliative care referrals across the four cohorts.
Of the 4,320,117 STEMI admissions, CS, CA and both were noted in 5.8%, 6.2% and 2.7%, respectively. In 2017, compared to 2000, there was an increase in CA (adjusted odds ratio [aOR] 1.83 [95% confidence interval {CI} 1.79-1.86]), CS (aOR 3.92 [95% CI 3.84-4.01]) and both (aOR 4.09 [95% CI 3.94-4.24]) (all p < 0.001). The CS+CA (77.2%) cohort had higher rates of multiorgan failure than CS only (59.7%) and CA only (26.3%), p < 0.001. The CA only cohort had lower rates (64%) of coronary angiography compared to the other groups (>70%), p < 0.001. In-hospital mortality was higher in CS+CA compared to CS alone (adjusted OR 1.87 [95% CI 1.83-1.91]), CA alone (adjusted OR 1.99 [95% CI 1.95-2.03]) or neither (aOR 18.37 [95% CI 18.02-18.71]). The CS+CA cohort had higher use of palliative care and DNR status. The presence of CS, either alone or in combination with CA, was associated with higher hospitalization costs.
The combination of CS and CA was associated with higher rates of non-cardiac organ failure and in-hospital mortality in STEMI compared to those with either CS or CA alone.
关于心源性休克（CS）和心脏骤停（CA）并发ST段抬高型心肌梗死（STEMI）的预后数据有限。
使用国家住院样本（2000 - 2017年）确定成年（>18岁）STEMI住院患者，并分为CS + CA、仅CS、仅CA和无CS/CA组。感兴趣的结局包括四个队列中的时间趋势、住院死亡率、住院费用、不复苏（DNR）状态的使用情况以及姑息治疗转诊情况。
在4320117例STEMI住院患者中，CS、CA和两者同时出现的比例分别为5.8%、6.2%和2.7%。与2000年相比，2017年CA（调整优势比[aOR] 1.83 [95%置信区间{CI} 1.79 - 1.86]）、CS（aOR 3.92 [95% CI 3.84 - 4.01]）和两者同时出现的情况（aOR 4.09 [95% CI 3.94 - 4.24]）均有所增加（所有p < 0.001）。CS + CA组（77.2%）的多器官衰竭发生率高于仅CS组（59.7%）和仅CA组（26.3%），p < 0.001。仅CA组的冠状动脉造影率（64%）低于其他组（>70%），p < 0.001。与单独的CS（调整后OR 1.87 [95% CI 1.83 - 1.91]）、单独的CA（调整后OR 1.99 [95% CI 1.95 - 2.03]）或两者都无（aOR 18.37 [95% CI 18.02 - 18.71]）相比，CS + CA组的住院死亡率更高。CS + CA组的姑息治疗和DNR状态的使用率更高。CS单独出现或与CA联合出现均与更高的住院费用相关。
与单独出现CS或CA相比，CS和CA联合出现与STEMI患者更高的非心脏器官衰竭率和住院死亡率相关。
