Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
Asian Cardiovasc Thorac Ann. 2021 Oct;29(8):751-757. doi: 10.1177/0218492320987918. Epub 2021 Jan 14.
Cardiogenic shock accounts for the majority of deaths amongst patients with ST-elevation myocardial infarction. Procalcitonin is elevated in acute myocardial infarction, especially when complicated by left heart failure, cardiogenic shock, resuscitated cardiac arrest, and bacterial infections. However, the prognostic utility of procalcitonin in ST-elevation myocardial infarction complicated by cardiogenic shock has not been systematically evaluated.
We performed a retrospective registry review of 125 patients with ST-elevation myocardial infarction and cardiogenic shock over 2 years at a tertiary referral hospital to examine the prognostic value of serum procalcitonin measurement at 24 hours after the onset of infarction for in-hospital mortality.
The mean age of the study population was 57.75 ± 11.1 years, and the median delay from onset to hospital admission was 15 hours. The in-hospital mortality was 28.8%. Receiver operating characteristic analysis revealed a strong relationship between elevated procalcitonin and in-hospital mortality (area under the curve = 0.676; = 0.002). Although procalcitonin was found to be higher in non-survivors in univariate analysis, it was not an independent predictor of mortality in multivariate regression analysis. Acute kidney injury, left ventricular ejection fraction, and non-revascularization were independently associated with mortality after adjusting for covariates.
Although procalcitonin was higher in non-survivors, static procalcitonin measurement at 24 hours after the onset of ST-elevation myocardial infarction complicated by cardiogenic shock was not an independent predictor of in-hospital mortality. Additional prospective studies are required to assess the role of serial procalcitonin monitoring in ST-elevation myocardial infarction complicated by cardiogenic shock.
心原性休克是 ST 段抬高型心肌梗死患者死亡的主要原因。降钙素原在急性心肌梗死中升高，尤其是在并发左心衰竭、心原性休克、复苏性心脏骤停和细菌感染时。然而，降钙素原在 ST 段抬高型心肌梗死并发心原性休克中的预后作用尚未得到系统评估。
我们对 2 年内在一家三级转诊医院因 ST 段抬高型心肌梗死并发心原性休克的 125 例患者进行了回顾性登记研究，以检查梗塞后 24 小时血清降钙素原测量对住院死亡率的预后价值。
研究人群的平均年龄为 57.75±11.1 岁，从发病到入院的中位延迟时间为 15 小时。住院死亡率为 28.8%。受试者工作特征分析显示，降钙素原升高与住院死亡率之间存在很强的关系（曲线下面积为 0.676；P=0.002）。虽然在单变量分析中发现存活者的降钙素原较高，但在多变量回归分析中它不是死亡率的独立预测因子。急性肾损伤、左心室射血分数和非血运重建在调整协变量后与死亡率独立相关。
虽然存活者的降钙素原较高，但 ST 段抬高型心肌梗死并发心原性休克患者在发病后 24 小时进行静态降钙素原测量并不是住院死亡率的独立预测因子。需要进一步的前瞻性研究来评估连续降钙素原监测在 ST 段抬高型心肌梗死并发心原性休克中的作用。
