美国应激性心肌病患者接受急性机械支持的早期临床结局

Early Clinical Outcomes of Patients With Stress-Induced Cardiomyopathy Receiving Acute Mechanical Support in the US.

作者信息

Jang Sun-Joo, Malaguez Webber Fabricio, Alam Md Mashiul, Bae Ju Young, Aggarwal Abhinav, Thomas Alexander, Zarich Stuart W, Ahmad Tariq, Miller P Elliott, Davila Carlos D

机构信息

Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut.

Department of Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport, Connecticut.

出版信息

J Soc Cardiovasc Angiogr Interv. 2023 Oct 9;2(6Part B):101185. doi: 10.1016/j.jscai.2023.101185. eCollection 2023 Nov-Dec.

BACKGROUND

The role of acute mechanical circulatory support (aMCS) in patients with stress-induced cardiomyopathy (SIC) complicated by cardiogenic shock (CS) is not well studied. Here, we describe the incidence and outcomes of aMCS use in SIC-CS using a large national database.

METHODS

Using the Nationwide Readmissions Database from January 2016 to November 2019, we identified patients hospitalized with SIC who received isolated intra-aortic balloon pump (IABP), microaxial flow pump (Impella, Abiomed), or extracorporeal membrane oxygenation (ECMO) during the index hospitalization.

RESULTS

A total of 902 among 94,709 hospitalizations for SIC (1.0%) required aMCS during the index hospitalization: 611 had IABP (67.7%), 189 had Impella (21.0%) and 102 had ECMO (11.3%). Patients with ECMO or Impella had higher in-hospital mortality rates than those with IABP (37.3% vs 29.1% vs 18.5%, respectively). There was an increased adjusted risk of in-hospital death with Impella (adjusted odds ratio [aOR], 1.98; 95% CI, 1.12-3.49) and ECMO (aOR, 4.15; 95% CI, 1.85-9.32) vs IABP. Impella was associated with an increased adjusted risk of 30-day readmission compared to IABP (aOR, 2.53; 95% CI, 1.16-5.51). Patients with ECMO or Impella had a higher incidence of renal replacement therapy and vascular/bleeding complications compared to those who received IABP.

CONCLUSIONS

In this nationwide analysis using an administrative database, patients who received ECMO and Impella showed higher rates of in-hospital mortality, renal replacement therapy, and vascular/bleeding complications compared to those who received IABP. Patients with more comorbidities may receive more aggressive hemodynamic support which may account for observed mortality differences. Future prospective studies with objective and universal characterization of baseline clinical and hemodynamic characteristics of patients with CS secondary to SIC are needed.

背景

急性机械循环支持（aMCS）在应激性心肌病（SIC）合并心源性休克（CS）患者中的作用尚未得到充分研究。在此，我们使用一个大型国家数据库描述aMCS在SIC-CS中的使用发生率和结局。

方法

利用2016年1月至2019年11月的全国再入院数据库，我们确定了因SIC住院且在本次住院期间接受单纯主动脉内球囊反搏（IABP）、微型轴流泵（Impella，Abiomed）或体外膜肺氧合（ECMO）的患者。

结果

在94709例SIC住院病例中，共有902例（1.0%）在本次住院期间需要aMCS：611例使用IABP（67.7%），189例使用Impella（21.0%），102例使用ECMO（11.3%）。使用ECMO或Impella的患者院内死亡率高于使用IABP的患者（分别为37.3%、29.1%和18.5%）。与IABP相比，使用Impella（调整后的优势比[aOR]，1.98；95%可信区间[CI]，1.12 - 3.49）和ECMO（aOR，4.15；95%CI，1.85 - 9.32）的患者院内死亡调整风险增加。与IABP相比，Impella与30天再入院的调整风险增加相关（aOR，2.53；95%CI，1.16 - 5.51）。与接受IABP的患者相比，使用ECMO或Impella的患者肾脏替代治疗和血管/出血并发症的发生率更高。

结论

在这项使用管理数据库的全国性分析中，与接受IABP的患者相比，接受ECMO和Impella的患者院内死亡率、肾脏替代治疗以及血管/出血并发症的发生率更高。合并症更多的患者可能接受了更积极的血流动力学支持，这可能解释了观察到的死亡率差异。未来需要对SIC继发CS患者的基线临床和血流动力学特征进行客观和通用表征的前瞻性研究。