经皮冠状动脉介入治疗中急性冠状动脉综合征心原性休克患者的心电图模式和临床结局 - 倾向评分分析。
Electrocardiographic patterns and clinical outcomes of acute coronary syndrome cardiogenic shock in patients undergoing percutaneous coronary intervention - A propensity score analysis.
机构信息
Western Health Department of Cardiology, Victoria, Australia; Baker Heart and Diabetes Institute, Victoria, Australia.
Department of Medicine, University of Melbourne, Victoria, Australia.
出版信息
Cardiovasc Revasc Med. 2024 Aug;65:58-64. doi: 10.1016/j.carrev.2024.02.022. Epub 2024 Mar 4.
OBJECTIVES
To determine the influence of presenting electrocardiographic (ECG) changes on prognosis in acute coronary syndrome cardiogenic shock (ACS-CS) patients undergoing percutaneous coronary angiography (PCI).
BACKGROUND
The effect of initial ECG changes such as ST-elevation myocardial infarction (STEMI) versus non-STEMI among patients ACS-CS on prognosis remains unclear.
METHODS
We analysed data from consecutive patients with ACS-CS enrolled in the Victorian Cardiac Outcomes registry between 2014 and 2020. Inverse probability of treatment weighting analysis (IPTW) was used to assess the effect of ECG changes on 30-day mortality.
RESULTS
Of 1564 patients with ACS-CS who underwent PCI, 161 had non-STEMI and 1403 had STEMI on ECG. The mean age was 66 ± 13 years, and 74 % (1152) were males. Patients with non-STEMI compared to STEMI were older (70 ± 12 vs 65 ± 13 years), had higher rates of diabetes (34 % vs 21 %), prior coronary artery bypass graft surgery (14 % vs 3.3 %), peripheral arterial disease (10.6 % vs 4.1 %, p < 0.01), and lower baseline eGFR (53.8 [37.1, 75.4] vs 65.3 [46.3, 87.8] ml/min/1.73m), all p ≤ 0.01. Non-STEMI patients were more likely to have a culprit left circumflex artery (29 % vs 20 %) and more often underwent multivessel percutaneous coronary intervention (30 % vs 20 %) but had lower rates of out-of-hospital cardiac arrest (21 % vs 39 %), all p ≤ 0.01. Propensity score analysis with IPTW confirmed that non-STEMI ECG was associated with lower odds for 30-day all-cause mortality (OR 0.47 [0.32, 0.69], p < 0.001), and 30-day major adverse cardiovascular and cerebrovascular events (OR 0.48 [0.33, 0.70]).
CONCLUSIONS
In patients undergoing PCI, Non-STEMI as compared to STEMI on index ECG was associated with approximately half the relative risk of both 30-day mortality and 30-day MACCE and could be a useful variable to integrate in ACS-CS risk scores.
目的
确定在接受经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征心原性休克（ACS-CS）患者中，心电图（ECG）改变对预后的影响。
背景
ACS-CS 患者初始 ECG 改变（如 ST 段抬高型心肌梗死 [STEMI] 与非 ST 段抬高型心肌梗死 [NSTEMI]）对预后的影响尚不清楚。
方法
我们分析了 2014 年至 2020 年期间连续纳入维多利亚心脏结局登记处的 ACS-CS 患者的数据。采用逆概率治疗加权分析（IPTW）评估 ECG 改变对 30 天死亡率的影响。
结果
在 1564 例接受 PCI 的 ACS-CS 患者中，161 例 ECG 为 NSTEMI，1403 例为 STEMI。平均年龄为 66 ± 13 岁，74%（1152 例）为男性。与 STEMI 相比，NSTEMI 患者年龄更大（70 ± 12 岁 vs 65 ± 13 岁），糖尿病发生率更高（34% vs 21%），先前接受过冠状动脉旁路移植术（14% vs 3.3%），外周动脉疾病（10.6% vs 4.1%，p<0.01），基线 eGFR 更低（53.8 [37.1，75.4] vs 65.3 [46.3，87.8] ml/min/1.73m），均 p<0.01。NSTEMI 患者更可能存在罪犯左回旋支（29% vs 20%），更常接受多支血管 PCI（30% vs 20%），但院外心脏骤停发生率更低（21% vs 39%），均 p<0.01。采用 IPTW 的倾向评分分析证实，与 STEMI 相比，NSTEMI 心电图与 30 天全因死亡率（OR 0.47 [0.32，0.69]，p<0.001）和 30 天主要不良心血管和脑血管事件（OR 0.48 [0.33，0.70]）的风险降低相关。
结论
在接受 PCI 的患者中，与 STEMI 相比，NSTEMI 指数 ECG 与 30 天死亡率和 30 天 MACCE 的风险降低相关，可能是 ACS-CS 风险评分中有用的整合变量。
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