Vallabhajosyula Saraschandra, Jentzer Jacob C, Prasad Abhiram, Sangaralingham Lindsey R, Kashani Kianoush, Shah Nilay D, Dunlay Shannon M
Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
ESC Heart Fail. 2021 Jun;8(3):2259-2269. doi: 10.1002/ehf2.13321. Epub 2021 Apr 9.
This study aims to evaluate the impact of the combination of cardiogenic shock (CS) and cardiac arrest (CA) complicating non-ST-segment elevation myocardial infarction (NSTEMI).
Adult (>18 years) NSTEMI admissions using the National Inpatient Sample database (2000 to 2017) were stratified by the presence of CA and/or CS. Outcomes of interest included in-hospital mortality, early coronary angiography, hospitalization costs, and length of stay. Of the 7 302 447 hospitalizations due to NSTEMI, 147 795 (2.0%) had CS only, 155 522 (2.1%) had CA only, and 41 360 (0.6%) had both CS and CA. Compared with 2000, the adjusted odds ratios (ORs) and 95% confidence interval (CIs) for CS, CA, and both CS and CA in 2017 were 3.75 (3.58-3.92), 1.46 (1.42-1.50), and 4.52 (4.16-4.87), respectively (all P < 0.001). The CS + CA (61.2%) cohort had higher multiorgan failure than CS (42.3%) and CA only (32.0%) cohorts, P < 0.001. The CA only cohort had lower rates of overall (52% vs. 59-60%) and early (17% vs. 18-27%) angiography compared with the other groups (all P < 0.001). CS + CA admissions had higher in-hospital mortality compared with those with CS alone (aOR 4.12 [95% CI 4.00-4.24]), CA alone (aOR 1.69 [95% CI 1.65-1.74]), or without CS/CA (aOR 22.66 [95% CI 22.06-23.27]). The presence of CS, either alone or with CA, was associated with higher hospitalization costs and longer hospital length of stay.
The combination of CS and CA is associated with higher rates of acute non-cardiac organ failure and in-hospital mortality in NSTEMI admissions as compared with those with either CS or CA alone.
本研究旨在评估心源性休克（CS）与心脏骤停（CA）合并非ST段抬高型心肌梗死（NSTEMI）的影响。
利用国家住院患者样本数据库（2000年至2017年）对成年（>18岁）NSTEMI入院患者按是否存在CA和/或CS进行分层。感兴趣的结局包括住院死亡率、早期冠状动脉造影、住院费用和住院时间。在7302447例因NSTEMI住院的患者中，147795例（2.0%）仅发生CS，155522例（2.1%）仅发生CA，41360例（0.6%）同时发生CS和CA。与2000年相比，2017年CS、CA以及同时发生CS和CA的校正比值比（OR）和95%置信区间（CI）分别为3.75（3.58 - 3.92）、1.46（1.42 - 1.50）和4.52（4.16 - 4.87）（均P < 0.001）。CS + CA队列（61.2%）的多器官衰竭发生率高于仅发生CS的队列（42.3%）和仅发生CA的队列（32.0%），P < 0.001。与其他组相比，仅发生CA的队列总体血管造影率（52%对59 - 60%）和早期血管造影率（17%对18 - 27%）较低（均P < 0.001）。与单独发生CS的患者（校正OR 4.12 [95% CI 4.00 - 4.24]）、单独发生CA的患者（校正OR 1.69 [95% CI 1.65 - 1.74]）或未发生CS/CA的患者（校正OR 22.66 [95% CI 22.06 - 23.27]）相比，CS + CA入院患者的住院死亡率更高。CS单独或与CA同时存在均与更高的住院费用和更长的住院时间相关。
与单独发生CS或CA的患者相比，CS和CA合并存在与NSTEMI入院患者更高的急性非心脏器官衰竭发生率和住院死亡率相关。
