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急性心肌梗死类型对心源性休克女性患者预后的影响。

Impact of Acute Myocardial Infarction Type on Prognosis in Female Patients With Cardiogenic Shock.

机构信息

Department of Cardiology, Ewha Womans University Medical Center Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea.

Department of Cardiology, Ewha Womans University Medical Center Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea.

出版信息

Am J Cardiol. 2023 Nov 1;206:116-124. doi: 10.1016/j.amjcard.2023.08.009. Epub 2023 Sep 8.

Abstract

There are limited data about mid-term prognosis according to acute myocardial infarction (AMI) type in female patients with AMI complicated by cardiogenic shock (CS). In this study, we evaluated the impact of AMI type on prognosis in female patients who underwent percutaneous coronary intervention (PCI) for AMI complicated by CS. A total of 184 female patients who underwent PCI for AMI complicated by CS were enrolled from 12 centers in the Republic of Korea. Patients were divided into 2 groups according to AMI type: the ST-segment elevation myocardial infarction (n = 114) and the non-ST-segment elevation myocardial infarction (n = 70) group. Primary outcome was a major adverse cardiac event (MACE) (defined as a composite of cardiac death, myocardial infarction, or repeat revascularization). Propensity-score matching analysis was performed to reduce selection bias and potential confounding factors. During 12-month follow-up, a total of 73 MACEs occurred (ST-segment elevation myocardial infarction group, 47 [41.2%] vs non-ST-segment elevation myocardial infarction group, 26 [37.1%], p = 0.643). Multivariate analysis revealed no significant difference in the incidence of MACE at 12 months between the 2 groups (adjusted hazard ratio 1.16, 95% confidence interval 0.70 to 2.37, p = 0.646). After propensity-score matching, the incidence of MACE at 12 months remained similar between the 2 groups (hazard ratio 1.31, 95% confidence interval 0.69 to 2.52, p = 0.413). The similarity in MACEs between the 2 groups was consistent across a variety of subgroups. In conclusion, after adjusting for baseline differences, AMI clinical type did not appear to increase the risk of MACEs at 12 months in female patients who underwent emergency PCI for AMI complicated by CS.

摘要

在因心原性休克(CS)并发急性心肌梗死(AMI)的女性患者中,根据 AMI 类型,有关中期预后的数据有限。在这项研究中,我们评估了 AMI 类型对因 CS 并发 AMI 而行经皮冠状动脉介入治疗(PCI)的女性患者预后的影响。共纳入韩国 12 个中心的 184 例因 CS 并发 AMI 而行 PCI 的女性患者。根据 AMI 类型将患者分为 2 组:ST 段抬高型心肌梗死(STEMI,n=114)和非 ST 段抬高型心肌梗死(NSTEMI,n=70)组。主要终点是主要不良心脏事件(MACE)(定义为心脏死亡、心肌梗死或再次血运重建的复合终点)。进行倾向评分匹配分析以减少选择偏倚和潜在的混杂因素。在 12 个月的随访期间,共发生 73 例 MACE(STEMI 组 47 例[41.2%] vs. NSTEMI 组 26 例[37.1%],p=0.643)。多变量分析显示,两组在 12 个月时的 MACE 发生率无显著差异(调整后的危险比 1.16,95%置信区间 0.70 至 2.37,p=0.646)。在进行倾向评分匹配后,两组在 12 个月时的 MACE 发生率仍相似(危险比 1.31,95%置信区间 0.69 至 2.52,p=0.413)。两组之间的 MACE 相似性在各种亚组中是一致的。总之,在校正基线差异后,对于因 CS 并发 AMI 而行紧急 PCI 的女性患者,AMI 临床类型似乎并未增加 12 个月时 MACE 的风险。

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