Cosentino Nicola, Resta Marta L, Somaschini Alberto, Campodonico Jeness, D'Aleo Giampaolo, Di Stefano Giovanni, Lucci Claudia, Moltrasio Marco, Bonomi Alice, Cornara Stefano, Demarchi Andrea, De Ferrari Gaetano, Bartorelli Antonio L, Marenzi Giancarlo
Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy.
Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology-Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.
J Clin Med. 2021 May 21;10(11):2237. doi: 10.3390/jcm10112237.
Cardiogenic shock (CS) is the leading cause of in-hospital mortality in ST-segment elevation myocardial infarction (STEMI). Only limited data are available on the long-term outcome of STEMI patients with CS undergoing contemporary treatment. We aimed to investigate long-term mortality and its predictors in STEMI patients with CS and to develop a risk score for long-term mortality prediction.
We retrospectively included 465 patients with STEMI complicated by CS and treated with primary angioplasty and intra-aortic balloon pump between 2005 and 2018. Long-term mortality, including both in-hospital mortality and all-cause mortality following discharge from the index hospitalization, was the primary endpoint. The long-term mortality (median follow-up 4 (2.0-5.2) years) was 60%, including in-hospital mortality (34%). At multivariate analysis, independent predictors of long-term mortality were age (HR 1.41, each 10-year increase), admission left ventricular ejection fraction (HR 1.51, each 10%-unit decrease) and creatinine (HR 1.28, each mg/dl increase), and acute kidney injury (HR 1.81). When these predictors were pooled together, the area under the curve (AUC) for long-term mortality was 0.80 (95% CI 0.75-0.84). Using the four variables, we developed a risk score with a mean (cross-validation analysis) AUC of 0.79. When the score was applied to in-hospital mortality, its AUC was 0.79, and 0.76 when the score was applied to all-cause mortality following discharge.
In STEMI patients with CS, the risk of death is still substantial in the years following the index event. A simple clinical score at the time of the index event accurately predicts long-term mortality risk.
心源性休克（CS）是ST段抬高型心肌梗死（STEMI）患者院内死亡的主要原因。关于接受当代治疗的STEMI合并CS患者的长期预后，仅有有限的数据。我们旨在研究STEMI合并CS患者的长期死亡率及其预测因素，并开发一种用于预测长期死亡率的风险评分。
我们回顾性纳入了2005年至2018年间465例STEMI合并CS并接受直接血管成形术和主动脉内球囊反搏治疗的患者。长期死亡率，包括院内死亡率和首次住院出院后的全因死亡率，是主要终点。长期死亡率（中位随访4（2.0 - 5.2）年）为60%，包括院内死亡率（34%）。多因素分析显示，长期死亡率的独立预测因素为年龄（HR 1.41，每增加10岁）、入院时左心室射血分数（HR 1.51，每降低10%）、肌酐（HR 1.28，每增加1mg/dl）以及急性肾损伤（HR 1.81）。当将这些预测因素合并在一起时，长期死亡率的曲线下面积（AUC）为0.80（95%CI 0.75 - 0.84）。使用这四个变量，我们开发了一个风险评分，其平均（交叉验证分析）AUC为0.79。当将该评分应用于院内死亡率时，其AUC为0.79，应用于出院后全因死亡率时，AUC为0.76。
在STEMI合并CS患者中，首次事件后的数年死亡风险仍然很高。首次事件时的一个简单临床评分能够准确预测长期死亡风险。
