Division of Cardiology, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan.
Division of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taoyuan, Taiwan.
Medicine (Baltimore). 2022 Sep 9;101(36):e30426. doi: 10.1097/MD.0000000000030426.
Acute myocardial infarction (AMI) complicated by cardiogenic shock has high mortality and remains challenging even in the revascularization era. We conducted this study to understand patients' outcomes. We retrospectively analyzed electronic medical records data from 1175 patients with AMI complicated by cardiogenic shock that developed within 3 days of admission to a multicenter medical care system between January 1, 2000, and July 31, 2018. Patients with AMI were classified into the ST-segment elevation MI (STEMI) group or the non-ST-segment elevation MI (NSTEMI) group. The short-term and 1-year mortality and adverse events after index admission were analyzed via logistic regression and a Cox proportional hazards model. When compared with NSTEMI, patients with STEMI tended to be younger (65.68 ± 14.05 years vs 70.70 ± 12.99 years, P < .001), men (73.29% vs 60.87%, P < .001), and have fewer underlying chronic diseases. Short-term mortality at index hospitalization was 14.83% in the STEMI group and 21.30% in the NSTEMI group; long-term mortality was 17.06% for the STEMI group and 24.13% for the NSTEMI group. No difference was observed between the 2 groups for patients who developed a cerebral vascular accident during the admission period. However, the major and gastrointestinal bleeding rates were higher in the STEMI group (2.66% vs 0.22%, P = .014; 3.36% vs 0.22%, P = .007, respectively). Age and respiratory failure were the most significant risk factors for short-term mortality. Revascularization may be beneficial for the short-term outcome but did not reach significance in multivariable analysis. In patients with AMI with cardiogenic shock, NSTEMI was associated with a significantly higher mortality rate in short-term results.
急性心肌梗死（AMI）并发心源性休克死亡率高，即使在血运重建时代，也仍然是一个挑战。我们进行这项研究是为了了解患者的预后。我们回顾性分析了 2000 年 1 月 1 日至 2018 年 7 月 31 日期间，一个多中心医疗系统内入院 3 天内发生的 AMI 并发心源性休克的 1175 例患者的电子病历数据。将 AMI 患者分为 ST 段抬高型心肌梗死（STEMI）组或非 ST 段抬高型心肌梗死（NSTEMI）组。通过 logistic 回归和 Cox 比例风险模型分析指数入院后的短期和 1 年死亡率及不良事件。与 NSTEMI 相比，STEMI 患者年龄较小（65.68±14.05 岁 vs 70.70±12.99 岁，P<0.001）、男性（73.29% vs 60.87%，P<0.001）、合并基础慢性病少。指数住院期间的短期死亡率，STEMI 组为 14.83%，NSTEMI 组为 21.30%；STEMI 组的长期死亡率为 17.06%，NSTEMI 组为 24.13%。住院期间发生脑血管意外的患者两组间无差异。然而，STEMI 组主要和胃肠道出血发生率较高（2.66% vs 0.22%，P=0.014；3.36% vs 0.22%，P=0.007）。年龄和呼吸衰竭是短期死亡率的最重要危险因素。血运重建可能对短期预后有益，但多变量分析未达到显著意义。在 AMI 并发心源性休克的患者中，NSTEMI 与短期结果的死亡率显著升高相关。
