Ryabov Vyacheslav V, Panteleev Oleg O, Kercheva Maria A, Gorokhovsky Alexei A, Syrkina Anna G, Margolis Natalia Y
Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 634012 Tomsk, Russia.
Cardiology Division, Siberian State Medical University, 2 Moscovsky Trakt, 634055 Tomsk, Russia.
J Clin Med. 2023 Dec 17;12(24):7739. doi: 10.3390/jcm12247739.
To access the features of the course of myocardial infarction (MI) in patients with different stages of MI complicated by cardiogenic shock (MI CS) according to the SCAI scale.
We retrospectively described the portrait of CS MI ( = 117) at different stages of SCAI from the hospital MI registry ( = 1253).
Hospital mortality increased from stage to stage ( ≤ 0.001). Significant differences in biochemical parameters were found both for indicators characterizing intensive care measures, such as the presence of mechanical lung ventilation or an intra-aortic balloon pump, and for indicators of organ hypoperfusion such as lactate level, pHv (7.39 (7.36; 7.44) at stage A-B; 7.14 (7.06; 7.18) at stage E), creatinine, and glomerular filtration rate. Parameters related to MI characteristics, such as instrumental and laboratory data, anamnesis of ischemia, and performed treatment, did not differ between groups. Polynomial logistic regression showed that lactate level, mechanical ventilation, and monocyte count upon admission (1.15 (0.96; 1.23) at stage A-B; 0.78 (0.49; 0.94) at stage E, = 0.005) correlated with CS severity.
The characteristics of MI at different stages of SCAI do not have differences and do not determine the severity of shock. We revealed a high discriminatory potential of the pH level in predicting refractory shock. The value of monocytes at admission may be a promising predictor of the severity of MI CS. The question of the causes of heterogeneity of MI CS, taking into account the homogeneity of MI characteristics, remains open and promising.
根据SCAI量表评估不同阶段心肌梗死（MI）合并心源性休克（MI CS）患者的心肌梗死病程特征。
我们从医院心肌梗死登记处（n = 1253）回顾性描述了处于SCAI不同阶段的CS MI患者（n = 117）的情况。
医院死亡率逐阶段增加（P≤0.001）。在表征重症监护措施的指标（如机械通气或主动脉内球囊泵的使用情况）以及器官低灌注指标（如乳酸水平、pHv（A - B阶段为7.39（7.36；7.44）；E阶段为7.14（7.06；7.18））、肌酐和肾小球滤过率）方面，均发现了生化参数的显著差异。与MI特征相关的参数，如仪器和实验室数据、缺血病史及所实施的治疗，在各组之间并无差异。多项式逻辑回归显示，乳酸水平、机械通气以及入院时的单核细胞计数（A - B阶段为1.15（0.96；1.23）；E阶段为0.78（0.49；0.94），P = 0.005）与CS严重程度相关。
SCAI不同阶段的MI特征并无差异，也不能决定休克的严重程度。我们发现pH水平在预测难治性休克方面具有较高的鉴别潜力。入院时单核细胞的值可能是MI CS严重程度的一个有前景的预测指标。考虑到MI特征的同质性，MI CS异质性的原因问题仍然悬而未决且颇具前景。
