Forner Jan, Schupp Tobias, Weidner Kathrin, Ruka Marinela, Egner-Walter Sascha, Behnes Michael, Akin Muharrem, Ayoub Mohamed, Mashayekhi Kambis, Akin Ibrahim, Rusnak Jonas
Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany.
European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany.
J Clin Med. 2023 Jul 24;12(14):4870. doi: 10.3390/jcm12144870.
Although previous studies investigated the influence of cardiovascular risk (CVR) factors in patients with acute coronary syndrome, data concerning the effect of CVR factors on the prognosis of patients with cardiogenic shock (CS) is scarce. Consecutive patients with CS were prospectively included from 2019 to 2021. The prognosis of patients with "low CVR" (i.e., 0-1 CVR factors) was compared to patients with "high CVR" (i.e., 2-4 CVR factors) according to presence or absence of arterial hypertension, diabetes mellitus, hyperlipidaemia or smoking. The primary endpoint was 30-day all-cause mortality. Statistical analyses included Kaplan-Meier and Cox proportional regression analyses. 273 consecutive patients with CS were included. 28% presented with low CVR and 72% with high CVR. Within the entire study cohort, the risk of 30-day all-cause mortality did not differ between patients with high and low CVR (55% vs. 57%; log rank = 0.727; HR = 0.942; 95% CI 0.663-1.338; = 0.738). Even after multivariable adjustment, high CVR was not associated with an elevated risk of 30-day all-cause mortality (HR = 1.039; 95% CI 0.648-1.667; = 0.873). The presence of arterial hypertension (55% vs. 58%; log rank = 0.564; HR = 0.906; 95% CI 0.638-1.287; = 0.582), diabetes mellitus (60% vs. 52%; log rank = 0.215; HR = 1.213; 95% CI 0.881-1.671; = 0.237) and a history of smoking (56% vs. 56%; log rank = 0.725; HR = 0.945; 95% CI 0.679-1.315; = 0.737) did not significantly influence short-term prognosis.. Only the absence of hyperlipidaemia significantly decreased the risk of all-cause mortality (65% vs. 51%; log rank = 0.038; HR = 0.718; 95% CI 0.516-0.998; = 0.049), which was no longer observed after multivariable adjustment (HR = 0.801; 95% CI 0.536-1.195; = 0.277). In conclusion, neither the overall CVR nor individual CVR factors were associated with the risk of 30-day all-cause mortality in patients with CS.
尽管先前的研究调查了心血管风险（CVR）因素对急性冠状动脉综合征患者的影响，但关于CVR因素对心源性休克（CS）患者预后影响的数据却很少。从2019年到2021年，前瞻性纳入了连续性的CS患者。根据是否存在动脉高血压、糖尿病、高脂血症或吸烟情况，将“低CVR”（即0 - 1个CVR因素）患者的预后与“高CVR”（即2 - 4个CVR因素）患者的预后进行比较。主要终点是30天全因死亡率。统计分析包括Kaplan-Meier分析和Cox比例回归分析。共纳入273例连续性CS患者。28%为低CVR，72%为高CVR。在整个研究队列中，高CVR和低CVR患者的30天全因死亡风险无差异（55%对57%；对数秩检验=0.727；风险比=0.942；95%置信区间0.663 - 1.338；P=0.738）。即使经过多变量调整，高CVR与30天全因死亡风险升高也无关联（风险比=1.039；95%置信区间0.648 - 1.667；P=0.873）。动脉高血压（55%对58%；对数秩检验=0.564；风险比=0.906；95%置信区间0.638 - 1.287；P=0.582）、糖尿病（60%对52%；对数秩检验=0.215；风险比=1.213；95%置信区间0.881 - 1.671；P=0.237）和吸烟史（56%对56%；对数秩检验=0.725；风险比=0.945；95%置信区间0.679 - 1.315；P=0.737）均未显著影响短期预后。只有无高脂血症显著降低了全因死亡风险（65%对51%；对数秩检验=0.038；风险比=0.718；95%置信区间0.516 - 0.998；P=0.049），但多变量调整后该情况不再存在（风险比=0.801；95%置信区间0.536 - 1.195；P=0.277）。总之，总体CVR和个体CVR因素均与CS患者的30天全因死亡风险无关。
