Okadome Yusuke, Morinaga Jun, Fukami Hirotaka, Hori Kota, Ito Teruhiko, Sato Michio, Miyata Keishi, Kuwabara Takashige, Mukoyama Masashi, Suzuki Ryusuke, Tsunoda Ryusuke, Oike Yuichi
Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University Kumamoto Japan.
Department of Clinical Engineering, Japanese Red Cross Kumamoto Hospital Kumamoto Japan.
Circ Rep. 2021 Oct 27;3(12):707-715. doi: 10.1253/circrep.CR-21-0043. eCollection 2021 Dec 10.
Patients with cardiogenic shock due to acute myocardial infarction (AMI) can rapidly undergo veno-arterial extracorporeal membrane oxygenation (VA-ECMO) therapy to recover cardiac output and decrease mortality. However, the clinical indicators predictive of mortality in these patients remain unknown. We conducted a single-center retrospective cohort study targeting AMI patients undergoing VA-ECMO. All 63 patients undergoing VA-ECMO for AMI at the Japanese Red Cross Kumamoto Hospital between January 1, 2010 and June 30, 2020 were enrolled. An exploratory analysis was conducted using a survival tree model and variables selected in a univariate Cox proportional hazard model. The median survival time from the start of VA-ECMO was 6.3 days, and 77.8% (n=49) of patients died. Survival analysis divided patients into 3 groups based on 2 parameters at the initial medical examination: Group 1, patients with neither hyperglycemia (blood glucose ≥213 mg/dL) nor thrombocytopenia (platelets ≤145,100/μL); Group 2, patients with hyperglycemia; and Group 3, patients with hyperglycemia plus thrombocytopenia. Relative to Group 1, the risk of in-hospital mortality was significantly increased in Group 2 (hazard ratio [HR] 2.25; 95% confidence interval [CI] 1.13-4.46), and that risk further increased in Group 3 (HR 7.60; 95% CI 3.21-17.95). Hyperglycemia plus thrombocytopenia on initial medical examination combinatorially increase the risk of mortality in patients with cardiogenic shock due to AMI undergoing VA-ECMO.
急性心肌梗死（AMI）所致心源性休克患者可迅速接受静脉-动脉体外膜肺氧合（VA-ECMO）治疗以恢复心输出量并降低死亡率。然而，这些患者死亡率的临床预测指标仍不明确。我们开展了一项单中心回顾性队列研究，以接受VA-ECMO治疗的AMI患者为研究对象。纳入了2010年1月1日至2020年6月30日期间在日本红十字熊本医院接受VA-ECMO治疗的所有63例AMI患者。使用生存树模型和单变量Cox比例风险模型中选择的变量进行探索性分析。从开始VA-ECMO起的中位生存时间为6.3天，77.8%（n=49）的患者死亡。生存分析根据初次体检时的2项参数将患者分为3组：第1组，既无高血糖（血糖≥213mg/dL）也无血小板减少（血小板≤145,100/μL）的患者；第2组，高血糖患者；第3组，高血糖合并血小板减少的患者。相对于第1组，第2组患者院内死亡风险显著增加（风险比[HR]2.25；95%置信区间[CI]1.13 - 4.46），第3组该风险进一步增加（HR 7.60；95%CI 3.21 - 17.95）。初次体检时高血糖合并血小板减少会联合增加接受VA-ECMO治疗的AMI所致心源性休克患者的死亡风险。
