Bilchenko Anton O, Gritsenko Olga V, Kolisnyk Volodymir O, Rafalyuk Oleg I, Pyzhevskii Andrii V, Myzak Yaroslav V, Besh Dmytro I, Salo Victor M, Chaichuk Sergii O, Lehoida Mykhailo O, Danylchuk Ihor V, Polivenok Ihor V
Department of Prevention and Treatment of Emergency Conditions, L.T. Malaya Therapy National Institute of the National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine.
Department of Interventional Cardiology, V.T. Zaitcev Institute of General and Urgent Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine.
Front Cardiovasc Med. 2024 Mar 28;11:1377969. doi: 10.3389/fcvm.2024.1377969. eCollection 2024.
Data on the results and management strategies in patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) in the Low and Lower-Middle Income Countries (LLMICs) are limited. This lack of understanding of the situation partially hinders the development of effective cardiogenic shock treatment programs in this part of the world.
The Ukrainian Multicentre Cardiogenic Shock Registry was analyzed, covering patient data from 2021 to 2022 in 6 major Ukrainian reperfusion centres from different parts of the country. Analysis was focusing on outcomes, therapeutic modalities and mortality predictors in AMI-CS patients.
We analyzed data from 221 consecutive patients with CS from 6 hospitals across Ukraine. The causes of CS were ST-elevated myocardial infarction (85.1%), non-ST-elevated myocardial infarction (5.9%), decompensated chronic heart failure (7.7%) and arrhythmia (1.3%), with a total in-hospital mortality rate for CS of 57.1%. The prevalence of CS was 6.3% of all AMI with reperfusion rate of 90.5% for AMI-CS. In 23.5% of cases, CS developed in the hospital after admission. Mechanical circulatory support (MCS) utilization was 19.9% using intra-aortic balloon pump alone. Left main stem occlusion, reperfusion deterioration, Charlson Comorbidity Index >4, and cardiac arrest were found to be independent predictors for hospital mortality in AMI-СS.
Despite the wide adoption of primary percutaneous coronary intervention as the main reperfusion strategy for AMI, СS remains a significant problem in LLMICs, associated with high in-hospital mortality. There is an unmet need for the development and implementation of a nationwide protocol for CS management and the creation of reference CS centers based on the country-wide reperfusion network, equipped with modern technologies for MCS.
低收入和中低收入国家（LLMICs）中急性心肌梗死合并心源性休克（AMI-CS）患者的治疗结果和管理策略数据有限。对这种情况的了解不足在一定程度上阻碍了世界这一地区有效心源性休克治疗方案的发展。
对乌克兰多中心心源性休克登记处进行了分析，涵盖了2021年至2022年来自该国不同地区的6个主要乌克兰再灌注中心的患者数据。分析重点是AMI-CS患者的治疗结果、治疗方式和死亡率预测因素。
我们分析了来自乌克兰6家医院的221例连续CS患者的数据。CS的病因包括ST段抬高型心肌梗死（85.1%）、非ST段抬高型心肌梗死（5.9%）、失代偿性慢性心力衰竭（7.7%）和心律失常（1.3%），CS的院内总死亡率为57.1%。CS的患病率为所有AMI的6.3%，AMI-CS的再灌注率为90.5%。在23.5%的病例中，CS在入院后在医院发生。单独使用主动脉内球囊泵的机械循环支持（MCS）使用率为19.9%。左主干闭塞、再灌注恶化、查尔森合并症指数>4和心脏骤停被发现是AMI-CS患者院内死亡的独立预测因素。
尽管广泛采用了直接经皮冠状动脉介入治疗作为AMI的主要再灌注策略，但CS在LLMICs中仍然是一个重大问题，与高院内死亡率相关。在制定和实施全国性CS管理方案以及基于全国再灌注网络建立配备现代MCS技术的参考CS中心方面仍有未满足的需求。
