接受Impella CP治疗的心源性休克患者与标准治疗的长期临床结局
Long-Term Clinical Outcome of Cardiogenic Shock Patients Undergoing Impella CP Treatment vs. Standard of Care.
作者信息
Scherer Clemens, Lüsebrink Enzo, Kupka Danny, Stocker Thomas J, Stark Konstantin, Stremmel Christopher, Orban Mathias, Petzold Tobias, Germayer Antonia, Mauthe Katharina, Kääb Stefan, Mehilli Julinda, Braun Daniel, Theiss Hans, Brunner Stefan, Hausleiter Jörg, Massberg Steffen, Orban Martin
机构信息
Intensive Care Unit and Department of Cardiology, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany.
DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany.
出版信息
J Clin Med. 2020 Nov 24;9(12):3803. doi: 10.3390/jcm9123803.
The number of patients treated with the mechanical circulatory support device Impella Cardiac Power (CP) for cardiogenic shock is steadily increasing. The aim of this study was to investigate long-term survival and complications related to this modality. Patients undergoing Impella CP treatment for cardiogenic shock were retrospectively enrolled and matched with cardiogenic shock patients not treated with mechanical circulatory support between 2010 and 2020. Data were collected from the cardiogenic shock registry of the university hospital of Munich (DRKS00015860). 70 patients with refractory cardiogenic shock without mechanical circulatory support were matched with 70 patients treated with Impella CP. At presentation, the mean age was 67 ± 15 years with 80% being male in the group without support and 67 ± 14 years ( = 0.97) with 76% being male ( = 0.68) in the group with Impella. There was no significant difference in the rate of cardiac arrest (47% vs. 51%, = 0.73) and myocardial infarction was the predominant cause of cardiogenic shock in both groups (70% vs. 77%). A total of 41% of patients without cardiocirculatory support and 54% of patients with Impella support died during the first month ( = 0.17). After one year, mortality rates were similar in both groups (55% in conventional vs. 59% in Impella CP group, = 0.30) as was mortality rate at long-term 5-years follow-up (64% in conventional vs. 73% in Impella CP group, = 0.33). The rate of clinically significant bleedings during ICU stay was lower in the conventional group than in the Impella support group (15% vs. 43%, = 0.002). In this small observational and non-randomized analysis no difference in long-term outcome between patients treated with Impella CP vs. guideline directed cardiogenic shock therapy without mechanical circulatory support could be detected. Care must be taken regarding the high rate of bleeding and vascular complications when using Impella CP. Large, adequately powered studies are urgently needed to investigate the efficacy and safety of Impella CP in cardiogenic shock.
使用Impella心脏动力（CP）机械循环支持装置治疗心源性休克的患者数量正在稳步增加。本研究的目的是调查与这种治疗方式相关的长期生存率和并发症。对2010年至2020年间接受Impella CP治疗心源性休克的患者进行回顾性登记，并与未接受机械循环支持的心源性休克患者进行匹配。数据收集自慕尼黑大学医院的心源性休克登记处（DRKS00015860）。70例难治性心源性休克且未接受机械循环支持的患者与70例接受Impella CP治疗的患者进行匹配。就诊时，无支持组的平均年龄为67±15岁，男性占80%；Impella组的平均年龄为67±14岁（P = 0.97），男性占76%（P = 0.68）。心脏骤停发生率无显著差异（47%对51%，P = 0.73），两组中心肌梗死均是心源性休克的主要原因（70%对77%）。未接受心脏循环支持的患者中有41%以及接受Impella支持的患者中有54%在第一个月内死亡（P = 0.17）。一年后，两组的死亡率相似（传统组为55%，Impella CP组为59%，P = 0.30），长期5年随访时的死亡率也相似（传统组为64%，Impella CP组为73%，P = 0.33）。重症监护病房（ICU）住院期间具有临床意义的出血发生率在传统组低于Impella支持组（15%对43%，P = 0.002）。在这项小型观察性非随机分析中，未发现接受Impella CP治疗的患者与未接受机械循环支持的指南指导的心源性休克治疗患者之间在长期结局上存在差异。使用Impella CP时必须注意其高出血率和血管并发症。迫切需要开展大规模且有足够样本量的研究来调查Impella CP在心源性休克中的疗效和安全性。
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