Department of Cardiology, Klinikum Ludwigshafen, Ludwigshafen, Germany; Department of Cardiology, Soroka University Medical Center, Be'er Sheva, Israel.
Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany.
Am J Cardiol. 2023 Jun 15;197:77-83. doi: 10.1016/j.amjcard.2023.04.007. Epub 2023 May 10.
Early revascularization therapy with percutaneous coronary intervention (PCI) has been shown to improve outcomes in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). Data from consecutive patients with AMI and CS treated with PCI enrolled into the prospective Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte-PCI registry were centrally collected and analyzed. Patients were divided into 4 groups with PCI for left main (LM), 1-vessel, 2-vessel, and 3-vessel diseases. Patients' characteristics, procedural features, antithrombotic therapies, and in-hospital complications were compared between the 4 groups. Between 2010 and 2015 a total of 2,348 consecutive patients with AMI and CS were treated by PCI in 51 hospitals, 295 for LM (15 for protected, 280 for unprotected) and single-vessel (n = 491), 2-vessel (n = 524), and 3-vessel disease (n = 1,038). Thrombolysis in myocardial infarction 3 patency of the culprit lesion after PCI was 84.3%, 84.0%, 80.8%, and 84.6% in single-vessel, 2-vessel, 3-vessel disease, and LM PCI, respectively, whereas in-hospital mortality was 27.9%, 33.9%, 46.5%, and 55.9%. Bleeding rates were low (2.0%-2.3 %) and not different between groups. In a multivariate analysis a higher age, thrombolysis in myocardial infarction flow <3 after PCI, 3-vessel disease, and LM PCI were independent predictors of mortality. In conclusion, PCI of the LM is performed in about 12.5% of patients with AMI and CS and was associated with a high procedural success rate, whereas mortality is increased with LM PCI.
急性心肌梗死（AMI）并发心源性休克（CS）患者行经皮冠状动脉介入治疗（PCI）的早期血运重建治疗已被证明可改善预后。对连续接受 PCI 治疗的 AMI 合并 CS 患者的数据进行了中心收集和分析，这些患者来自前瞻性 Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte-PCI 注册登记研究。将患者分为 4 组，分别为左主干（LM）、1 支血管、2 支血管和 3 支血管病变行 PCI 治疗。比较了 4 组患者的特征、手术特点、抗栓治疗和住院并发症。2010 年至 2015 年，51 家医院共对 2348 例 AMI 合并 CS 患者进行了 PCI 治疗，其中 295 例行 LM（保护型 280 例，非保护型 15 例）和单支血管（n=491）、2 支血管（n=524）和 3 支血管病变（n=1038）。PCI 后罪犯病变的心肌梗死溶栓治疗（TIMI）3 级血流的通畅率分别为单支血管、2 支血管、3 支血管病变和 LM PCI 为 84.3%、84.0%、80.8%和 84.6%，住院死亡率分别为 27.9%、33.9%、46.5%和 55.9%。出血率较低（2.0%-2.3%），各组间无差异。多变量分析显示，年龄较高、PCI 后 TIMI 血流<3、3 支血管病变和 LM PCI 是死亡的独立预测因素。总之，在 AMI 合并 CS 患者中，约 12.5%行 LM PCI，该术式与较高的手术成功率相关，但 LM PCI 与死亡率升高相关。
