2954Wayne State University, School of Medicine, MI, USA.
12262University of Massachusetts School of Medicine, Worcester, MA, USA.
J Intensive Care Med. 2022 Aug;37(8):1094-1100. doi: 10.1177/08850666211061731. Epub 2021 Nov 23.
To study coronary interventions and mortality among patients with ST-elevated myocardial infarction (STEMI) who were admitted with septic shock.
Data from the national emergency department sample (NEDS) that constitutes 20% sample of hospital-owned emergency departments in the United States was analyzed for the septic shock related visits from 2016 to 2018. Septic shock was defined by the ICD codes.
Out of 1 375 507 adult septic shock patients, 521 300 had a primary diagnosis of septic shock (mean age 67.41±15.67 years, 51.1% females) in the national emergency database for the years 2016 to 2018. Of these patients, 2768 (0.53%) had STEMI recorded during the hospitalization. Mortality rates for STEMI patients were higher than patients without STEMI (52.3% vs 23.5%). Mortality rates improved with PCI among STEMI patients (43.8% vs 56.2%). Coronary angiography was performed among 16% of patients of which percutaneous coronary intervention (PCI) rates were 7.7% among patients with STEMI septic shock. PCI numerically improved mortality, however, had no significant difference than patients without PCI on multivariate logistic regression and univariate logistic regression post coarsened exact matching of baseline characteristics among STEMI patients. Among the predictors, STEMI was a significant predictor of mortality in septic shock patients (OR 2.87, 95% CI 2.37-3.49; <.001). Age, peripheral vascular disease, were predominant predictors of mortality in STEMI with septic shock subgroup ( <.001). Pneumonia was the predominant underlying infection among STEMI (36.4%) and without STEMI group (29.5%).
STEMI complicating septic shock worsens mortality. PCI and coronary angiography numerically improved mortality, however, had no significant difference from patients without PCI. More research will be needed to improve mortality in such a critically ill subgroup of patients.
研究因感染性休克入院的 ST 段抬高型心肌梗死（STEMI）患者的冠状动脉介入治疗和死亡率。
对 2016 年至 2018 年美国医院所有急诊部门的全国急诊部门样本（NEDS）进行分析，以确定与感染性休克相关的就诊患者数据。感染性休克通过 ICD 编码进行定义。
在 2016 年至 2018 年全国急诊数据库中，1375507 例成年感染性休克患者中，有 521300 例患者（平均年龄 67.41±15.67 岁，51.1%为女性）的主要诊断为感染性休克。在这些患者中，2768 例（0.53%）在住院期间记录有 STEMI。STEMI 患者的死亡率高于无 STEMI 的患者（52.3%比 23.5%）。STEMI 患者行 PCI 治疗后死亡率降低（43.8%比 56.2%）。对 16%的患者进行了冠状动脉造影，其中 PCI 率为 7.7%。在 STEMI 合并感染性休克患者中，PCI 虽然在数值上降低了死亡率，但多变量逻辑回归和在 STEMI 患者中进行基线特征的粗化精确匹配后的单变量逻辑回归分析均显示，与未行 PCI 治疗的患者相比，差异无统计学意义。在预测因素中，STEMI 是感染性休克患者死亡的显著预测因素（OR 2.87，95%CI 2.37-3.49；<0.001）。年龄、外周血管疾病是 STEMI 合并感染性休克亚组患者死亡的主要预测因素（<0.001）。肺炎是 STEMI（36.4%）和非 STEMI 组（29.5%）中最主要的潜在感染。
STEMI 合并感染性休克会使死亡率恶化。PCI 和冠状动脉造影虽然在数值上改善了死亡率，但与未行 PCI 治疗的患者相比，差异无统计学意义。需要进一步研究以改善此类危重症患者亚组的死亡率。
