Ishii Masanobu, Tsujita Kenichi, Okamoto Hiroshi, Koto Satoshi, Nishi Takeshi, Nakai Michikazu, Sumita Yoko, Iwanaga Yoshitaka, Azuma Nobuyoshi, Matoba Satoaki, Hirata Ken-Ichi, Hikichi Yutaka, Yokoi Hiroyoshi, Ikari Yuji, Uemura Shiro
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
Cardiovascular Medicine, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama 701-0192, Japan.
Eur Heart J Open. 2021 Dec 31;2(1):oeab047. doi: 10.1093/ehjopen/oeab047. eCollection 2022 Jan.
Although primary percutaneous coronary intervention (PCI) and mechanical circulatory support (MCS), such as extracorporeal membrane oxygenation (ECMO) or intra-aortic balloon pumping (IABP), have been widely used for acute myocardial infarction (AMI) patients with cardiogenic shock (AMICS), their in-hospital mortality remains high. This study aimed to investigate the association of cardiovascular healthcare resources with 30-day mortality in AMICS.
This was an observational study using a Japanese nationwide administrative data (JROAD-DPC) of 260 543 AMI patients between April 2012 and March 2018. Of these, 45 836 AMICS patients were divided into three categories based on MCS use: with MCS (ECMO with/without IABP), IABP only, or without MCS. Certified hospital density and number of board-certified cardiologists were used as a metric of cardiovascular healthcare resources. We estimated the association of MCS use, cardiovascular healthcare resources, and 30-day mortality. The 30-day mortality was 71.2% for the MCS, 23.9% for IABP only, and 37.8% for the group without MCS. The propensity score-matched and inverse probability-weighted Cox frailty models showed that primary PCI was associated with a low risk for mortality. Higher hospital density and larger number of cardiologists in the responsible hospitals were associated with a lower risk for mortality.
Although the 30-day mortality remained extremely high in AMICS, indication of primary PCI and improvement in providing cardiovascular healthcare resources associated with the short-term prognosis of AMICS.
尽管直接经皮冠状动脉介入治疗（PCI）和机械循环支持（MCS），如体外膜肺氧合（ECMO）或主动脉内球囊反搏（IABP），已广泛应用于急性心肌梗死（AMI）合并心源性休克（AMICS）的患者，但其院内死亡率仍然很高。本研究旨在探讨心血管医疗资源与AMICS患者30天死亡率之间的关联。
这是一项观察性研究，使用了2012年4月至2018年3月期间260543例AMI患者的日本全国行政数据（JROAD-DPC）。其中，45836例AMICS患者根据MCS的使用情况分为三类：使用MCS（ECMO联合或不联合IABP）、仅使用IABP或未使用MCS。认证医院密度和认证心脏病专家数量被用作心血管医疗资源的指标。我们评估了MCS的使用、心血管医疗资源与30天死亡率之间的关联。使用MCS的患者30天死亡率为71.2%，仅使用IABP的患者为23.9%，未使用MCS的患者为37.8%。倾向评分匹配和逆概率加权Cox脆弱模型显示，直接PCI与低死亡风险相关。责任医院中较高的医院密度和较多的心脏病专家数量与较低的死亡风险相关。
尽管AMICS患者的30天死亡率仍然极高，但直接PCI的应用以及心血管医疗资源的改善与AMICS的短期预后相关。
