在 COVID-19 期间出现急性心肌梗死和心源性休克的患者的特征和结局。
Characteristics and outcomes of patients presenting with acute myocardial infarction and cardiogenic shock during COVID-19.
机构信息
Department of Medicine, Ronald Reagan-UCLA Medical Center, Los Angeles, California, USA.
Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, California, USA.
出版信息
Catheter Cardiovasc Interv. 2022 Oct;100(4):568-574. doi: 10.1002/ccd.30390. Epub 2022 Sep 7.
OBJECTIVES
To evaluate characteristics and outcomes of patients presenting with acute myocardial infarction and cardiogenic shock (AMICS) during the coronavirus disease 2019 (COVID-19) pandemic.
BACKGROUND
The COVID-19 pandemic has created challenges in delivering acute cardiovascular care. Quality measures and outcomes of patients presenting with AMICS during COVID-19 in the United States have not been well described.
METHODS
We identified 406 patients from the National Cardiogenic Shock Initiative (NCSI) with AMICS and divided them into those presenting before (N = 346, 5/9/2016-2/29/2020) and those presenting during the COVID-19 pandemic (N = 60, 3/1/2020-11/10/2020). We compared baseline clinical data, admission characteristics, and outcomes.
RESULTS
The median age of the cohort was 64 years, and 23.7% of the group was female. There were no significant differences in age, sex, and medical comorbidities between the two groups. Patients presenting during the pandemic were less likely to be Black compared to those presenting prior. Median door to balloon (90 vs. 88 min, p = 0.38), door to support (88 vs. 78 min, p = 0.13), and the onset of shock to support (74 vs. 62 min, p = 0.15) times were not significantly different between the two groups. Patients presented with ST-elevation myocardial infarction more often during the COVID-19 period (95.0% vs. 80.0%, p = 0.005). In adjusted logistic regression models, COVID-19 period did not significantly associate with survival to discharge (odds ratio [OR] 1.09, 95% confidence interval [CI] 0.54-2.19, p = 0.81) or with 1-month survival (OR 0.82, 95% CI 0.42-1.61, p = 0.56).
CONCLUSIONS
Care of patients presenting with AMICS has remained robust among hospitals participating in the NCSI during the COVID-19 pandemic.
目的
评估在 2019 年冠状病毒病（COVID-19）大流行期间出现急性心肌梗死合并心原性休克（AMICS）的患者的特征和结局。
背景
COVID-19 大流行给急性心血管治疗带来了挑战。美国在 COVID-19 期间出现 AMICS 的患者的质量指标和结局尚未得到很好的描述。
方法
我们从国家心原性休克倡议（NCSI）中确定了 406 名 AMICS 患者，并将其分为在 COVID-19 大流行之前（N = 346，2016 年 5 月 9 日至 2020 年 2 月 29 日）和 COVID-19 大流行期间（N = 60，2020 年 3 月 1 日至 11 月 10 日）就诊的患者。我们比较了两组的基线临床数据、入院特征和结局。
结果
该队列的中位年龄为 64 岁，其中 23.7%为女性。两组间在年龄、性别和合并症方面无显著差异。与之前就诊的患者相比，大流行期间就诊的患者黑人比例较低。两组间门球时间（90 分钟 vs. 88 分钟，p = 0.38）、门支持时间（88 分钟 vs. 78 分钟，p = 0.13）和休克发生至支持时间（74 分钟 vs. 62 分钟，p = 0.15）均无显著差异。在 COVID-19 期间，患者更常出现 ST 段抬高型心肌梗死（95.0% vs. 80.0%，p = 0.005）。在调整后的逻辑回归模型中，COVID-19 期与出院时存活（比值比[OR] 1.09，95%置信区间[CI] 0.54-2.19，p = 0.81）或 1 个月存活（OR 0.82，95%CI 0.42-1.61，p = 0.56）无显著相关性。
结论
在 COVID-19 大流行期间，参与 NCSI 的医院对出现 AMICS 的患者的治疗仍然稳健。
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