Jiang Yi, Boris Awadji Fabrice, Zhu Yuansong, Gan Hongbo, Hu Xiankang, Xue Yuzhou, Xiang Zhenxian, Sasmita Bryan Richard, Liu Gang, Luo Suxin, Huang Bi
Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Am J Cardiol. 2022 Mar 15;167:20-26. doi: 10.1016/j.amjcard.2021.11.040. Epub 2022 Jan 2.
The 2016 European Society of Cardiology Guidelines introduced a new term, mid-range left ventricular ejection fraction (mrEF) heart failure, however, the clinical characteristics and short-term outcomes in cardiogenic shock patients with mrEF after acute myocardial infarction remain unclear. This retrospective study analyzed the baseline characteristics, management, and outcomes according to the left ventricular ejection fraction (LVEF), reduced LVEF (rEF) ≤40%, mrEF 41% to 49%, and preserved LVEF (pEF) ≥50% in patients with acute myocardial infarction complicated by cardiogenic shock. The primary end point was 30-day all-cause mortality and the secondary end point was the composite events of major adverse cardiovascular events (MACEs). In 218 patients, 71 (32.6%) were patients with mrEF. Compared with those with pEF, patients with mrEF had some similar clinical characteristics to that of rEF. The 30-day all-cause mortality in patients with rEF, mrEF, and pEF were 72.7%, 56.3%, and 32.0%, respectively (p = 0.001). The 30-day MACE were 90.9%, 69.0%, and 60.2%, respectively (p = 0.001). After multivariable adjustment, patients with mrEF and rEF had comparable 30-day all-cause mortality (hazard ratio [HR] = 0.81, 95% confidence interval [CI] 0.50 to 1.33, p = 0.404), and pEF was associated with decreased risk of 30-day all-cause mortality compared with rEF (HR = 0.41, 95% CI 0.24 to 0.71, p = 0.001). In contrast, the risk of 30-day MACE in mrEF and pEF were lower than that of rEF (HR = 0.62, 95% CI 0.40 to 0.96, p = 0.031 and HR = 0.53, 95% CI 0.34 to 0.80, p = 0.003, respectively). In conclusion, 1/3 of patients with acute myocardial infarction complicated by cardiogenic shock were mrEF. The clinical characteristics and short-term mortality in patients with mrEF were inclined to that of rEF and the occurrence of early left ventricular systolic dysfunction is of prognostic significance.
2016年欧洲心脏病学会指南引入了一个新术语，即射血分数处于中间范围（mrEF）的心衰，但急性心肌梗死后合并心源性休克的mrEF患者的临床特征和短期预后仍不明确。本回顾性研究根据急性心肌梗死合并心源性休克患者的左心室射血分数（LVEF）进行分析，将其分为射血分数降低（rEF）≤40%、mrEF为41%至49%和射血分数保留（pEF）≥50%三组，分析其基线特征、治疗及预后情况。主要终点为30天全因死亡率，次要终点为主要不良心血管事件（MACE）的复合事件。在218例患者中，71例（32.6%）为mrEF患者。与pEF患者相比，mrEF患者具有一些与rEF患者相似的临床特征。rEF、mrEF和pEF患者的30天全因死亡率分别为72.7%、56.3%和32.0%（p = 0.001）。30天MACE发生率分别为90.9%、69.0%和60.2%（p = 0.001）。多变量调整后，mrEF和rEF患者的30天全因死亡率相当（风险比[HR]=0.81，95%置信区间[CI]为0.50至1.33，p = 0.404），与rEF相比，pEF与30天全因死亡率风险降低相关（HR = 0.41，95%CI为0.24至0.71，p = 0.001）。相比之下，mrEF和pEF患者的30天MACE风险低于rEF（HR分别为0.62，95%CI为0.40至0.96，p = 0.031；HR为0.53，95%CI为0.34至0.80，p = 0.003）。总之，急性心肌梗死合并心源性休克患者中有1/3为mrEF。mrEF患者的临床特征和短期死亡率倾向于rEF患者，早期左心室收缩功能障碍的发生具有预后意义。
