心源性休克患者入院和发病时间对预后的影响。

Effect of Admission and Onset Time on the Prognosis of Patients With Cardiogenic Shock.

机构信息

Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim.

Department of Internal Medicine and Cardiology, Mediclin Heart Centre Lahr, Lahr.

出版信息

Chest. 2024 Jan;165(1):110-127. doi: 10.1016/j.chest.2023.08.011. Epub 2023 Aug 12.

DOI:10.1016/j.chest.2023.08.011

PMID:37579943

Abstract

BACKGROUND

The spectrum of patients with cardiogenic shock (CS) has changed significantly over time. CS has become especially more common in the absence of acute myocardial infarction (AMI), while this subset of patients was typically excluded from recent studies. Furthermore the prognostic impact of onset time and onset place due to CS has rarely been investigated.

RESEARCH QUESTION

Do the place of CS onset (out-of-hospital, ie, primary CS vs in-hospital, ie, secondary CS) and the onset time of out-of-hospital CS (ie, on-hours vs off-hours admission) affect the risk of all-cause mortality at 30 days?

STUDY DESIGN AND METHODS

This prospective monocentric registry included consecutive patients with CS of any cause from 2019 until 2021. First, the prognostic impact of the place of CS onset (out-of-hospital, ie, primary CS vs during hospitalization, ie, secondary CS) was investigated. Thereafter, the prognostic impact of the onset time of out-of-hospital CS was investigated. Furthermore, the prognostic impact of causative AMI vs non-AMI was investigated. Statistical analyses included Kaplan-Meier analyses, and univariable and multivariable Cox regression analyses.

RESULTS

Two hundred seventy-three patients with CS were included prospectively (64% with primary out-of-hospital CS). The place of CS onset was not associated with increased risk of all-cause mortality within the entire study cohort (secondary in-hospital CS: hazard ratio [HR], 1.532; 95% CI, 0.990-2.371; P = .06). However, increased risk of 30-day all-cause mortality was seen in patients with AMI related secondary in-hospital CS (HR, 2.087; 95% CI, 1.126-3.868; P = .02). Furthermore, primary out-of-hospital CS admitted during off-hours was associated with lower risk of all-cause mortality compared to primary CS admitted during on-hours (HR, 0.497; 95% CI, 0.302-0.817; P = .01), irrespective of the presence or absence of AMI.

INTERPRETATION

Primary and secondary CS were associated with comparable, whereas primary out-of-hospital CS admitted during off-hours was associated with lower risk of all-cause mortality at 30 days.

TRIAL REGISTRY

ClinicalTrials.gov; No.: NCT05575856; URL: www.

CLINICALTRIALS

gov.

摘要

背景

心源性休克（CS）患者的谱已随时间发生显著变化。CS 在没有急性心肌梗死（AMI）的情况下变得尤为常见，而这组患者通常被排除在最近的研究之外。此外，CS 发病时间和发病地点的预后影响很少被研究。

研究问题

CS 发病地点（院外，即原发性 CS 与院内，即继发性 CS）和院外 CS 发病时间（即上班时间与下班时间入院）是否会影响 30 天全因死亡率？

研究设计和方法

本前瞻性单中心登记研究纳入了 2019 年至 2021 年期间因任何原因导致 CS 的连续患者。首先，研究了 CS 发病地点（院外，即原发性 CS 与住院期间，即继发性 CS）的预后影响。此后，研究了院外 CS 发病时间的预后影响。此外，还研究了病因性 AMI 与非 AMI 的预后影响。统计分析包括 Kaplan-Meier 分析、单变量和多变量 Cox 回归分析。

结果

前瞻性纳入了 273 例 CS 患者（64%为原发性院外 CS）。CS 发病地点与整个研究队列的全因死亡率增加无关（继发性院内 CS：危险比 [HR]，1.532；95%CI，0.990-2.371；P=0.06）。然而，与 AMI 相关的继发性院内 CS 患者的 30 天全因死亡率增加（HR，2.087；95%CI，1.126-3.868；P=0.02）。此外，与上班时间入院相比，下班时间入院的原发性院外 CS 与全因死亡率降低相关（HR，0.497；95%CI，0.302-0.817；P=0.01），无论是否存在 AMI。