Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA (S.S.S., C.M.R., B.N.T., A.G.T., A.A.D., M.D., S.S.D., K.C.E., C.d., M.C.F., L.G., H.M., J.J.P., M.A.P., A.R., P.S., M.W.S., R.S., D.T., K.D.Y., T.W., C.M.O., W.B.B.).
Georgetown University Medical School' Washington' DC (A.M.).
Circ Heart Fail. 2022 Jun;15(6):e009279. doi: 10.1161/CIRCHEARTFAILURE.121.009279. Epub 2022 May 5.
Little is known about clinical characteristics, hospital course, and longitudinal outcomes of patients with cardiogenic shock (CS) related to heart failure (HF-CS) compared to acute myocardial infarction (AMI; CS related to AMI [AMI-CS]).
We examined in-hospital and 1-year outcomes of 520 (219 AMI-CS, 301 HF-CS) consecutive patients with CS (January 3, 2017-December 31, 2019) in a single-center registry.
Mean age was 61.5±13.5 years, 71% were male, 22% were Black patients, and 63% had chronic kidney disease. The HF-CS cohort was younger (58.5 versus 65.6 years, <0.001), had fewer cardiac arrests (15.9% versus 35.2%, <0.001), less vasopressor utilization (61.8% versus 82.2%, <0.001), higher pulmonary artery pulsatility index (2.14 versus 1.51, <0.01), lower cardiac power output (0.64 versus 0.77 W, <0.01) and higher pulmonary capillary wedge pressure (25.4 versus 22.2 mm Hg, <0.001) than patients with AMI-CS. Patients with HF-CS received less temporary mechanical circulatory support (34.9% versus 76.3% <0.001) and experienced lower rates of major bleeding (17.3% versus 26.0%, 0.02) and in-hospital mortality (23.9% versus 39.3%, <0.001). Postdischarge, 133 AMI-CS and 229 patients with HF-CS experienced similar rates of 30-day readmission (19.5% versus 24.5%, =0.30) and major adverse cardiac and cerebrovascular events (23.3% versus 28.8%, =0.45). Patients with HF-CS had lower 1-year mortality (n=123, 42.6%) compared to the patients with AMI-CS (n=110, 52.9%, =0.03). Cumulative 1-year mortality was also lower in patients with HF-CS (log-rank test, =0.04).
Patients with HF-CS were younger, and despite lower cardiac power output and higher pulmonary capillary wedge pressure, less likely to receive vasopressors or temporary mechanical circulatory support. Although patients with HF-CS had lower in-hospital and 1-year mortality, both cohorts experienced similarly high rates of postdischarge major adverse cardiovascular and cerebrovascular events and 30-day readmission, highlighting that both cohorts warrant careful long-term follow-up.
URL: https://www.
gov; Unique identifier: NCT03378739.
与急性心肌梗死（AMI；与 AMI 相关的心源性休克[AMI-CS]）相比，心力衰竭（HF；与 HF 相关的心源性休克[HF-CS]）相关的心源性休克患者的临床特征、住院过程和长期预后知之甚少。
我们在一个单中心注册研究中检查了 520 例连续的心源性休克（CS）患者（2017 年 1 月 3 日至 2019 年 12 月 31 日）的院内和 1 年结局，其中 219 例为 AMI-CS，301 例为 HF-CS。
平均年龄为 61.5±13.5 岁，71%为男性，22%为黑人患者，63%患有慢性肾脏病。HF-CS 组更年轻（58.5 岁 vs 65.6 岁，<0.001），心脏骤停发生率较低（15.9% vs 35.2%，<0.001），血管加压药使用率较低（61.8% vs 82.2%，<0.001），肺动脉搏动指数较高（2.14 比 1.51，<0.01），心输出量较低（0.64 比 0.77 W，<0.01），肺毛细血管楔压较高（25.4 比 22.2 mmHg，<0.001）。HF-CS 患者接受的临时机械循环支持较少（34.9% vs 76.3%，<0.001），大出血发生率较低（17.3% vs 26.0%，0.02）和院内死亡率较低（23.9% vs 39.3%，<0.001）。出院后，133 例 AMI-CS 和 229 例 HF-CS 患者 30 天再入院率相似（19.5% vs 24.5%，=0.30），主要不良心脑血管事件发生率相似（23.3% vs 28.8%，=0.45）。HF-CS 患者 1 年死亡率（n=123，42.6%）低于 AMI-CS 患者（n=110，52.9%，=0.03）。HF-CS 患者的 1 年累积死亡率也较低（对数秩检验，=0.04）。
HF-CS 患者较年轻，尽管心输出量较低，肺毛细血管楔压较高，但接受血管加压药或临时机械循环支持的可能性较小。尽管 HF-CS 患者的院内和 1 年死亡率较低，但两组患者出院后主要不良心血管和脑血管事件以及 30 天再入院率均较高，这表明两组患者均需要密切的长期随访。
网址：https://www.
gov；唯一标识符：NCT03378739。
