Karami Mina, Peters Elma J, Lagrand Wim K, Houterman Saskia, den Uil Corstiaan A, Engström Annemarie E, Otterspoor Luuk C, Ottevanger Jan Paul, Ferreira Irlando A, Montero-Cabezas Jose M, Sjauw Krischan, van Ramshorst Jan, Kraaijeveld Adriaan O, Verouden Niels J W, Lipsic Erik, Vlaar Alexander P, Henriques Jose P S
Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
J Clin Med. 2021 May 11;10(10):2047. doi: 10.3390/jcm10102047.
It is important to gain more insight into the cardiogenic shock (CS) population, as currently, little is known on how to improve outcomes. Therefore, we assessed clinical outcome in acute coronary syndrome (ACS) patients treated by percutaneous coronary intervention (PCI) with and without CS at admission. Furthermore, the incidence of CS and predictors for mortality in CS patients were evaluated. The Netherlands Heart Registration (NHR) is a nationwide registry on all cardiac interventions. We used NHR data of ACS patients treated with PCI between 2015 and 2019. Among 75,407 ACS patients treated with PCI, 3028 patients (4.1%) were identified with CS, respectively 4.3%, 3.9%, 3.5%, and 4.3% per year. Factors associated with mortality in CS were age (HR 1.02, 95%CI 1.02-1.03), eGFR (HR 0.98, 95%CI 0.98-0.99), diabetes mellitus (DM) (HR 1.25, 95%CI 1.08-1.45), multivessel disease (HR 1.22, 95%CI 1.06-1.39), prior myocardial infarction (MI) (HR 1.24, 95%CI 1.06-1.45), and out-of-hospital cardiac arrest (OHCA) (HR 1.71, 95%CI 1.50-1.94). In conclusion, in this Dutch nationwide registry-based study of ACS patients treated by PCI, the incidence of CS was 4.1% over the 4-year study period. Predictors for mortality in CS were higher age, renal insufficiency, presence of DM, multivessel disease, prior MI, and OHCA.
深入了解心源性休克（CS）人群非常重要，因为目前对于如何改善其预后知之甚少。因此，我们评估了入院时接受经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）患者，无论有无CS的临床结局。此外，还评估了CS患者中CS的发生率及死亡率预测因素。荷兰心脏注册研究（NHR）是一项关于所有心脏介入治疗的全国性注册研究。我们使用了2015年至2019年间接受PCI治疗的ACS患者的NHR数据。在75407例接受PCI治疗的ACS患者中，3028例（4.1%）被诊断为CS，每年分别为4.3%、3.9%、3.5%和4.3%。与CS患者死亡率相关的因素包括年龄（HR 1.02，95%CI 1.02 - 1.03）、估算肾小球滤过率（eGFR）（HR 0.98，95%CI 0.98 - 0.99）、糖尿病（DM）（HR 1.25，95%CI 1.08 - 1.45）、多支血管病变（HR 1.22，95%CI 1.06 - 1.39）、既往心肌梗死（MI）（HR 1.24，95%CI 1.06 - 1.45）和院外心脏骤停（OHCA）（HR 1.71，95%CI 1.50 - 1.94）。总之，在这项基于荷兰全国性注册研究的PCI治疗ACS患者研究中，4年研究期间CS的发生率为4.1%。CS患者死亡率的预测因素包括年龄较大、肾功能不全、DM、多支血管病变、既往MI和OHCA。
