Castillo Costa Yanina, Delfino Flavio, Mauro Víctor, D'Imperio Heraldo, Barrero Carlos, Charask Adrián, Zoni Rodrigo, Macín Stella, Perna Eduardo, Gagliardi Juan
Argentine Society of Cardiology, Argentine Federation of Cardiology, Grupo ARGEN IAM ST.
Argentine Society of Cardiology, Argentine Federation of Cardiology, Grupo ARGEN IAM ST.
Curr Probl Cardiol. 2023 Feb;48(2):101468. doi: 10.1016/j.cpcardiol.2022.101468. Epub 2022 Oct 17.
Cardiogenic Shock is one of the main causes of death in ST segment Elevation Myocardial Infarction. To know the clinical characteristics, in-hospital evolution and mortality of patients with Cardiogenic Shock. Patients enrolled in the ARGEN-IAM-ST Registry were analyzed. Predictors of Cardiogenic Shock and death during hospital stay were established. A total of 6122 patients were admitted between 2015 and 2022. Cardiogenic Shock was present in 10.75% of cases. Patients with CS were older (64.5 vs 60 years), more females (41% vs 36%), with more antecedents of infarction and a higher prevalence of anterior location of infarction and multivessel disease. They were also less revascularized (88.5% vs 91.5%) and had a higher incidence of failed angioplasty (15.7% vs 2.7%). They also evidenced a higher occurrence of mechanical complications (6.8% vs 0.4%), ischemic recurrence (7.4% vs 3.4%) and cardiac arrest on admission (44.8% vs 2.6%). All the differences described showed statistical significance with P < 0.05. Overall mortality was 58% in contrast to 2.77% in patients without Cardiogenic Shock (P < 0.001). Only age, DBT, and early cardiac arrest were independent predictors of shock on admission whereas age, female gender, cardiac arrest on admission and failed angioplasty were independent predictors of death. One out of 10 patients with ST Elevation Myocardial Infarction presented cardiogenic shock. Its clinical characteristics were similar to those described more than 20 years ago. Despite a high use of reperfusion strategy cardiogenic shock continues to have a very high mortality Argentina.
心源性休克是ST段抬高型心肌梗死的主要死亡原因之一。为了解心源性休克患者的临床特征、住院期间病情演变及死亡率，对纳入ARGEN - IAM - ST注册研究的患者进行了分析，确定了心源性休克和住院期间死亡的预测因素。2015年至2022年期间共收治6122例患者，其中10.75%的病例存在心源性休克。心源性休克患者年龄更大（64.5岁对60岁），女性更多（41%对36%），梗死病史更多，梗死前壁位置和多支血管病变的患病率更高。他们接受血管再通治疗的比例也更低（88.5%对91.5%），血管成形术失败的发生率更高（15.7%对2.7%）。他们还表现出更高的机械并发症发生率（6.8%对0.4%）、缺血复发率（7.4%对3.4%）和入院时心脏骤停发生率（44.8%对2.6%）。所有这些差异均具有统计学意义，P < 0.05。总体死亡率为58%，而无心源性休克患者的死亡率为2.77%（P < 0.001）。仅年龄、糖尿病和早期心脏骤停是入院时休克的独立预测因素，而年龄、女性性别、入院时心脏骤停和血管成形术失败是死亡的独立预测因素。每10例ST段抬高型心肌梗死患者中就有1例出现心源性休克。其临床特征与20多年前描述的相似。尽管再灌注策略的使用率很高，但在阿根廷，心源性休克的死亡率仍然非常高。
