Division of Cardiology, Department of Medicine (A.K., J.A.C., G.C.W., C.B.F.), University of British Columbia, Vancouver, Canada.
Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L., J.S.), University of British Columbia, Vancouver, Canada.
Circ Cardiovasc Interv. 2023 Jun;16(6):e012810. doi: 10.1161/CIRCINTERVENTIONS.122.012810. Epub 2023 Jun 20.
Mortality remains high in patients with ST-segment-elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS), and early reperfusion has been shown to improve outcomes. We analyzed the association between first medical contact (FMC)-to-percutaneous coronary angiography time with mortality and major adverse cardiovascular events among patients with STEMI with and without CS.
We performed a retrospective analysis of the Vancouver Coastal Health Authority STEMI registry, including all patients with STEMI who received primary percutaneous coronary angiography between January 1, 2010, and December 31, 2020, and stratified them by presence or absence of CS at hospital arrival. The primary outcome was in-hospital mortality, the secondary outcome was in-hospital major adverse cardiovascular events, defined as a composite of the first occurrence of mortality, cardiac arrest, heart failure, intracerebral hemorrhage, cerebrovascular accident, or reinfarction. Mixed effects logistic regression with restricted cubic splines was used to estimate the relationships between FMC-to-device time and the outcomes in the CS and non-CS groups.
2929 patients were included, 9.4% (n=275) had CS. Median FMC-to-device time was 113.5 (interquartile range, 93.0-145.0) and 103.0 (interquartile range, 85.0-130.0) minutes for patients with CS and without CS, respectively. More patients with CS had FMC-to-device times above guideline recommendations (76.6% versus 54.1%, <0.001). Between 60 and 90 minutes, for each 10-minute increase in FMC-to-device time, absolute mortality for patients with CS increased by 4% to 7%, whereas for patients without CS, it increased by <0.5%.
Among patients with STEMI undergoing primary percutaneous coronary angiography, reperfusion delays among patients with CS are associated with significantly worse outcomes. Strategies to reduce FMC-to-device times for patients with STEMI presenting with CS are required.
ST 段抬高型心肌梗死（STEMI）并发心原性休克（CS）患者的死亡率仍然很高，早期再灌注已被证明可以改善预后。我们分析了 STEMI 患者中首次医疗接触（FMC）至经皮冠状动脉造影时间与死亡率和主要不良心血管事件之间的关系，这些患者有或没有 CS。
我们对温哥华沿海卫生局 STEMI 注册中心进行了回顾性分析，包括 2010 年 1 月 1 日至 2020 年 12 月 31 日期间接受直接经皮冠状动脉造影的所有 STEMI 患者，并根据入院时是否存在 CS 对患者进行分层。主要结局是院内死亡率，次要结局是院内主要不良心血管事件，定义为死亡率、心脏骤停、心力衰竭、颅内出血、脑血管意外或再梗死首次发生的复合事件。采用带有限制立方样条的混合效应逻辑回归来估计 CS 组和非 CS 组中 FMC 至设备时间与结局之间的关系。
共纳入 2929 例患者，9.4%（n=275）为 CS。CS 患者的中位 FMC 至设备时间为 113.5（四分位间距，93.0-145.0）分钟，非 CS 患者的中位 FMC 至设备时间为 103.0（四分位间距，85.0-130.0）分钟。CS 患者中有更多的患者 FMC 至设备时间超过指南推荐的时间（76.6%比 54.1%，<0.001）。在 60 至 90 分钟之间，CS 患者的 FMC 至设备时间每增加 10 分钟，死亡率绝对增加 4%至 7%，而非 CS 患者的死亡率绝对增加小于 0.5%。
在接受直接经皮冠状动脉造影的 STEMI 患者中，CS 患者的再灌注延迟与预后显著恶化相关。需要采取策略来减少 CS 患者的 FMC 至设备时间。
