Djohan Andie Hartanto, Evangelista Lauren Kay Mance, Chan Koo-Hui, Lin Weiqin, Adinath Anand Ambhore, Kua Jie Li, Sim Hui Wen, Chan Mark Y, Ng Gavin, Cherian Robin, Wong Raymond C C, Lee Chi-Hang, Tan Huay-Cheem, Yeo Tiong-Cheng, Yip James, Low Adrian F, Sia Ching-Hui, Loh Poay Huan
Department of Cardiology, National University Heart Centre Singapore, Singapore.
Division of Cardiology, Department of Medicine, Ng Teng Fong General Hospital, Singapore.
Int J Cardiol Heart Vasc. 2024 Jul 12;53:101463. doi: 10.1016/j.ijcha.2024.101463. eCollection 2024 Aug.
Cardiogenic shock (CS) complicating myocardial infarction is associated with poor outcomes. Data among Asian populations are scarce. We aimed to investigate the long-term outcomes, prognostic factors, and predictors of CS among Asian ST elevation myocardial infarction (STEMI) patients.
This was a retrospective cohort study of consecutive patients undergoing primary percutaneous coronary intervention (PPCI) for STEMI within our regional STEMI network between 2015 and 2019. The long-term outcomes of those with and without CS were compared. Clinical predictors of outcomes and development of CS were investigated.
A total of 1791 patients who underwent PPCI were included. Patients completed at least 2 years' follow-up with a median follow-up period of 2.6 years (IQR 1.0, 3,9). Overall, 208/1791 (11.6 %) STEMI patients developed CS. These patients were older (61.1 ± 12.5 vs 57.8 ± 12.2, P < 0.001) and mostly men (87.0 %). All-cause mortality (59.9 % vs 4.7 % P < 0.001), cardiac mortality (43.8 % vs 2.2 %, P < 0.001) and major adverse cardiovascular events (MACE) was significantly higher in the CS group (59.1 % vs 14.0 %, P < 0.001). Independent predictors of survival were higher index LVEF (adjusted hazards ratio [aHR] 0.967, 95 %CI 0.951-0.984, p < 0.001) and higher arterial pH at onset of shock (aHR 0.750, 0.626-0.897, p = 0.002). Increased serum lactate concentration independently predicts poor prognosis (aHR 1.084, 95 % CI 1.046-1.124, p < 0.001).
In Asian STEMI patients who underwent PPCI, CS was associated with poor outcomes. Higher LVEF on index admission was associated with better outcomes; while lactic acidosis independently predicted mortality.
心肌梗死并发的心源性休克（CS）与不良预后相关。亚洲人群中的相关数据较少。我们旨在调查亚洲ST段抬高型心肌梗死（STEMI）患者中CS的长期预后、预后因素及预测因素。
这是一项对2015年至2019年间在我们地区STEMI网络内行直接经皮冠状动脉介入治疗（PPCI）的连续患者进行的回顾性队列研究。比较了发生CS和未发生CS患者的长期预后。研究了预后及CS发生的临床预测因素。
共纳入1791例行PPCI的患者。患者完成了至少2年的随访，中位随访期为2.6年（四分位间距1.0，3.9）。总体而言，1791例STEMI患者中有208例（11.6%）发生了CS。这些患者年龄更大（61.1±12.5岁对57.8±12.2岁，P<0.001），且大多为男性（87.0%）。CS组的全因死亡率（59.9%对4.7%，P<0.001）、心脏死亡率（43.8%对2.2%，P<0.001）和主要不良心血管事件（MACE）显著更高（59.1%对14.0%，P<0.001）。生存的独立预测因素为较高的入院时左室射血分数（LVEF）（调整后风险比[aHR]0.967，95%置信区间[CI]0.951 - 0.984，p<0.001）和休克发作时较高的动脉血pH值（aHR 0.750，0.626 - 0.897，p = 0.002）。血清乳酸浓度升高独立预测预后不良（aHR 1.084，95% CI 1.046 - 1.124，p<0.001）。
在接受PPCI的亚洲STEMI患者中，CS与不良预后相关。入院时较高的LVEF与较好的预后相关；而乳酸酸中毒独立预测死亡率。
