Daoulah Amin, Alshehri Mohammed, Panduranga Prashanth, Aloui Hatem M, Yousif Nooraldaem, Arabi Abdulrahman, Almahmeed Wael, Qutub Mohammed A, Elmahrouk Ahmed, Arafat Amr A, Kanbr Omar, Fathey Hussien Adnan, Abdulhadi Aldossari Mubarak, Al Mefarrej Abdulmohsen H, Shahzad Chachar Tarique, Amin Haitham, Livingston Gladsy Selva, Mohamed Al Rawahi Abeer Said, Alswuaidi Jassim, Hashmani Shahrukh, Al Jarallah Mohammed, Ghani Mohamed Ajaz, Alzahrani Badr, Jameel Naser Maryam, Qenawi Wael, Hassan Taher, Alenezi Abdullah, Hersi Ahmad S, Alharbi Waleed, Al Obaikan Sultan, Saad Almalki Salman, Mohammed Ballool Sulafa Almukhtar, Noor Husam A, Khalid AlSuwaidi Manar, Antony Harvey, Albasiouny Alkholy Marwa Abd Elghany, Alkhodari Khaled, Khan Hassan, Alshehri Ali, Ghonim Ahmed A, Abualnaja Seraj, Abdirahman Kahin Mokhtar, Rajan Rajesh, Almerri Khaled, Al Nasser Faisal Omar M, Alhaydhal Ahmed, Ashour Mohammed Awad, Elamin Omer A, Jamjoom Ahmed, Wedinly Sary Mahmoud, Elmahrouk Youssef, Dahdouh Ziad, Ross Ethan M, Al Maashani Said, Abohasan Abdulwali, Tawfik Wael, Balghith Mohammed, Elganady Abdelmaksoud, Abdulhabeeb Ibrahim A M, Borini Rasha Mohammed, Basardah Ayman, Alqahtani Abdulrahman M, Aldossari Alaa, Alsuayri Abdullah Omair, Khan Mushira, Lotfi Amir
Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia.
Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Kingdom of Saudi Arabia.
Shock. 2024 Oct 1;62(4):512-521. doi: 10.1097/SHK.0000000000002433. Epub 2024 Aug 12.
Background: There is a paucity of data regarding acute myocardial infarction (MI) complicated by cardiogenic shock (AMI-CS) in the Gulf region. This study addressed this knowledge gap by examining patients experiencing AMI-CS in the Gulf region and analyzing hospital and short-term follow-up mortality. Methods: The Gulf-Cardiogenic Shock registry included 1,513 patients with AMI-CS diagnosed between January 2020 and December 2022. Results: The incidence of AMI-CS was 4.1% (1,513/37,379). The median age was 60 years. The most common presentation was ST-elevation MI (73.83%). In-hospital mortality was 45.5%. Majority of patients were in SCAI (Society for Cardiovascular Angiography and Interventions shock classification) stage D and E (68.94%). Factors associated with hospital mortality were previous coronary artery bypass graft (odds ratio [OR]: 2.49; 95% confidence interval [CI]: 1.321-4.693), cerebrovascular accident (OR: 1.621; 95% CI: 1.032-2.547), chronic kidney disease (OR: 1.572; 95% CI: 1.158-2.136), non-ST-elevation MI (OR: 1.744; 95% CI: 1.058-2.873), cardiac arrest (OR: 5.702; 95% CI: 3.640-8.933), SCAI stage D and E (OR: 19.146; 95% CI: 9.902-37.017), prolonged QRS (OR: 10.012; 95% CI: 1.006-1.019), right ventricular dysfunction (OR: 1.679; 95% CI: 1.267-2.226), and ventricular septal rupture (OR: 6.008; 95% CI: 2.256-15.998). Forty percent had invasive hemodynamic monitoring, 90.02% underwent revascularization, and 45.80% received mechanical circulatory support (41.31% had intra-aortic balloon pump and 14.21% had extracorporeal membrane oxygenation/Impella devices). Survival at 12 months was 51.49% (95% CI: 46.44%-56.29%). Conclusions: The study highlighted the significant burden of AMI-CS in this region, with high in-hospital mortality. The study identified several key risk factors associated with increased hospital mortality. Despite the utilization of invasive hemodynamic monitoring, revascularization, and mechanical circulatory support in a substantial proportion of patients, the 12-month survival rate remained relatively low.
关于海湾地区急性心肌梗死（MI）合并心源性休克（AMI-CS）的数据匮乏。本研究通过对海湾地区发生AMI-CS的患者进行检查，并分析医院及短期随访死亡率，填补了这一知识空白。方法：海湾心源性休克登记处纳入了2020年1月至2022年12月期间诊断为AMI-CS的1513例患者。结果：AMI-CS的发病率为4.1%（1513/37379）。中位年龄为60岁。最常见的表现为ST段抬高型心肌梗死（73.83%）。住院死亡率为45.5%。大多数患者处于心血管造影和介入学会（SCAI）休克分级的D期和E期（68.94%）。与住院死亡率相关的因素包括既往冠状动脉旁路移植术（比值比[OR]：2.49；95%置信区间[CI]：1.321 - 4.693）、脑血管意外（OR：1.621；95% CI：1.032 - 2.547）、慢性肾脏病（OR：1.572；95% CI：1.158 - 2.136）、非ST段抬高型心肌梗死（OR：1.744；95% CI：1.058 - 2.873）、心脏骤停（OR：5.702；95% CI：3.640 - 8.933）、SCAI D期和E期（OR：19.146；95% CI：9.902 - 37.017）、QRS波增宽（OR：10.012；95% CI：1.006 - 1.019）、右心室功能障碍（OR：1.679；95% CI：1.267 - 2.226）和室间隔破裂（OR：6.008；95% CI：2.256 - 15.998）。40%的患者进行了有创血流动力学监测，90.02%的患者接受了血运重建，45.80%的患者接受了机械循环支持（41.31%使用了主动脉内球囊反搏，14.21%使用了体外膜肺氧合/Impella装置）。12个月时的生存率为51.49%（95% CI：46.44% - 56.29%）。结论：该研究凸显了该地区AMI-CS的沉重负担以及较高的住院死亡率。该研究确定了几个与住院死亡率增加相关的关键危险因素。尽管相当一部分患者使用了有创血流动力学监测、血运重建和机械循环支持，但12个月生存率仍然相对较低。
