ST段抬高型心肌梗死合并心源性休克患者的死亡率：一项全国性PCI注册研究结果及对左主干PCI的关注

Mortality in STEMI Patients With Cardiogenic Shock: Results From a Nationwide PCI Registry and Focus on Left Main PCI.

作者信息

Kayaert Peter, Coeman Mathieu, Demolder Anthony, Gevaert Sofie, Schaubroeck Hannah, Claeys Marc J, Hanet Claude, Beauloye Christophe, Desmet Walter, De Pauw Michel, Haine Steven, Taeymans Yves

机构信息

Dienst Cardiologie Universitair Ziekenhuis Gent, Corneel Heymanslaan 10, 9000 Gent, Belgium.

出版信息

J Invasive Cardiol. 2022 Feb;34(2):E142-E148. doi: 10.25270/jic/21.00148.

DOI:10.25270/jic/21.00148

PMID:35100557

Abstract

BACKGROUND

The study aims to assess real-life short- and long-term outcomes of patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) complicated with cardiogenic shock (CS). Outcome after left main (LM) PCI is of particular interest.

METHODS

Procedural, 30-day, and >30-day mortality rates were assessed in 2744 CS-STEMI patients enrolled between 2012 and 2019 in a nationwide registry involving 49 centers.

RESULTS

Procedural, 30-day, and >30-day mortality rates were 6.9%, 39.8%, and 12.6%, respectively. The mortality rates were significantly higher in the 348 patients (12.7%) who underwent LM-PCI (13.5%, 59.5%, and 18.4%, respectively). LM-PCI, a suboptimal PCI result, and transfemoral access were independent predictors of procedural and 30-day mortality. Operator experience was an independent predictor of procedural mortality, but not 30-day mortality.

CONCLUSIONS

Mortality remains high in CS-STEMI patients, especially within the first month. Patients undergoing LM-PCI are particularly at risk. Operator experience is predictive of procedural mortality.

摘要

背景

本研究旨在评估因ST段抬高型心肌梗死（STEMI）并发心源性休克（CS）而接受直接经皮冠状动脉介入治疗（PCI）的患者的实际短期和长期预后。左主干（LM）PCI后的预后尤其令人关注。

方法

在2012年至2019年期间纳入全国49个中心登记处的2744例CS-STEMI患者中评估手术、30天和超过30天的死亡率。

结果

手术、30天和超过30天的死亡率分别为6.9%、39.8%和12.6%。在接受LM-PCI的348例患者（12.7%）中，死亡率显著更高（分别为13.5%、59.5%和18.4%）。LM-PCI、PCI结果欠佳和经股动脉途径是手术和30天死亡率的独立预测因素。术者经验是手术死亡率的独立预测因素，但不是30天死亡率的独立预测因素。