Anhui Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China (mainland).
Department of Respiratory, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, Anhui, China (mainland).
Med Sci Monit. 2021 Jul 3;27:e929996. doi: 10.12659/MSM.929996.
BACKGROUND Patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) usually have high mortality. This study aimed to identify factors related to the short-term survival of patients with AMI and CS treated by percutaneous coronary intervention (PCI) under intra-aortic balloon pump (IABP) support. MATERIAL AND METHODS This retrospective study included consecutive patients with AMI and CS treated with PCI under IABP support. Clinical characteristics, including the infarct-related artery, lesion number, aspiration catheter usage, conventional or delayed stenting, and thrombolysis in myocardial infarction (TIMI) flow grade before and after PCI, were collected. Patients were followed up postoperatively for 30 days. Multivariate logistic regression was used to identify factors associated with the 30-day mortality. RESULTS There were marked differences between the nonsurvival group (n=49) and the survival group (n=92) in the no-reflow after surgery (49.0% vs 14.1%, P<0.001), postoperative TIMI grade 3 flow (65.3% vs 91.3%, P<0.001), and delayed stent implantation (18.4% vs 37.0%, P=0.022). Factors associated with 30-day mortality were postoperative TIMI grade 3 flow (odds ratio [OR]: 0.227; 95% confidence interval [CI]: 0.076-0.678; P=0.008), delayed stent implantation (OR: 0.371; 95% CI: 0.139-0.988; P=0.047), and intraoperative no-reflow (OR: 2.737; 95% CI: 1.084-6.911; P=0.033). CONCLUSIONS For patients with AMI complicated by CS treated with emergent PCI under IABP support, prevention of no-reflow during surgery by delayed stent implantation can reduce postoperative 30-day mortality in selected cases.
急性心肌梗死（AMI）并发心源性休克（CS）的患者通常死亡率较高。本研究旨在确定经主动脉内球囊泵（IABP）支持下经皮冠状动脉介入治疗（PCI）治疗的 AMI 合并 CS 患者短期生存的相关因素。
本回顾性研究纳入了接受 IABP 支持下 PCI 治疗的 AMI 合并 CS 的连续患者。收集临床特征，包括梗死相关动脉、病变数量、抽吸导管使用、常规或延迟支架置入以及 PCI 前后的心肌梗死溶栓治疗（TIMI）血流分级。术后对患者进行 30 天随访。采用多变量逻辑回归分析确定与 30 天死亡率相关的因素。
在术后无复流（49.0% vs. 14.1%，P<0.001）、术后 TIMI 血流 3 级（65.3% vs. 91.3%，P<0.001）和延迟支架植入（18.4% vs. 37.0%，P=0.022）方面，非存活组（n=49）与存活组（n=92）之间存在显著差异。与 30 天死亡率相关的因素包括术后 TIMI 血流 3 级（优势比 [OR]：0.227；95%置信区间 [CI]：0.076-0.678；P=0.008）、延迟支架植入（OR：0.371；95% CI：0.139-0.988；P=0.047）和术中无复流（OR：2.737；95% CI：1.084-6.911；P=0.033）。
对于接受 IABP 支持下紧急 PCI 治疗的 AMI 合并 CS 患者，通过延迟支架植入预防术中无复流可降低选定病例术后 30 天的死亡率。
