Kanhouche Gabriel, Nicolau Jose Carlos, de Mendonça Furtado Remo Holanda, Carvalho Luiz Sérgio, Dalçoquio Talia Falcão, Pileggi Brunna, de Sa Marchi Mauricio Felippi, Abi-Kair Pedro, Lopes Neuza, Giraldez Roberto Rocha, Baracioli Luciano Moreira, Lima Felipe Gallego, Hajjar Ludhmila Abrahão, Filho Roberto Kalil, de Brito Junior Fábio Sandoli, Abizaid Alexandre, Ribeiro Henrique Barbosa
Department of Interventional Cardiology, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
Department of Cardiology, Brazilian Clinical Research Institute, São Paulo, Brazil.
Eur Heart J Open. 2024 Sep 3;4(5):oeae075. doi: 10.1093/ehjopen/oeae075. eCollection 2024 Sep.
Cardiogenic shock (CS) and cardiac arrest (CA) are serious complications in ST-elevation myocardial infarction (STEMI) patients, with lack of long-term data according to their timing of occurrence. This study sought to determine the incidence and relationship between the timing of occurrence and prognostic impact of CS and CA complicating STEMI in the long-term follow-up.
We conducted a retrospective analysis of consecutive STEMI patients treated between 2004 and 2017. Patients were divided into four groups based on the occurrence of neither CA nor CS, CA only, CS only, and both CA and CS (CA-CS-, CA+, CS+, and CA+CS+, respectively). Adjusted Cox regression analysis was used to assess the independent association between the CS and CA categories and mortality. A total of 1603 STEMI patients were followed for a median of 3.6 years. CA and CS occurred in the 12.2% and 15.9% of patients, and both impacted long-term mortality [adjusted hazard ratio (HR) = 2.59, 95% confidence interval (CI): 1.53-4.41, < 0.001; HR = 3.16, 95% CI: 2.21-4.53, < 0.001, respectively). CA+CS+ occurred in 7.3%, with the strongest association with higher mortality (adjusted HR = 5.36; 95% CI: 3.80-7.55, < 0.001). Using flexible parametric models with B-splines, the increased mortality was restricted to the first ∼10 months. In addition, overall mortality rates were higher at all timings (all with < 0.001), except for CA during initial cardiac catheterization ( < 0.183).
CS and CA complicating patients presenting with STEMI were associated with higher long-term mortality rate, especially in the first 10 months. Both CS+ and CA+ at any timeframe impacted outcomes, except for CA+ during the initial cardiac catheterization, although this will have to be confirmed in larger future studies, given the relatively small number of patients.
心源性休克（CS）和心脏骤停（CA）是ST段抬高型心肌梗死（STEMI）患者的严重并发症，目前缺乏关于其发生时间的长期数据。本研究旨在确定在长期随访中，CS和CA并发STEMI的发生率、发生时间与预后影响之间的关系。
我们对2004年至2017年间连续治疗的STEMI患者进行了回顾性分析。根据是否发生CA和CS，将患者分为四组，即既无CA也无CS、仅发生CA、仅发生CS以及同时发生CA和CS（分别为CA-CS-、CA+、CS+和CA+CS+）。采用校正Cox回归分析评估CS和CA类别与死亡率之间的独立关联。共对1603例STEMI患者进行了中位时间为3.6年的随访。CA和CS分别发生在12.2%和15.9%的患者中，两者均影响长期死亡率[校正风险比（HR）=2.59，95%置信区间（CI）：1.53-4.41，P<0.001；HR = 3.16，95%CI：2.21-4.53，P<0.001]。CA+CS+发生在7.3%的患者中，与更高的死亡率关联最强（校正HR = 5.36；95%CI：3.80-7.55，P<0.001）。使用带有B样条的灵活参数模型，死亡率增加仅限于最初的约10个月。此外，除了初始心脏导管插入术期间发生CA外（P<0.183），在所有时间点总体死亡率均较高（均P<0.001）。
并发STEMI的患者发生CS和CA与较高的长期死亡率相关，尤其是在最初10个月内。在任何时间段，CS+和CA+均会影响预后，但初始心脏导管插入术期间发生CA+的情况除外，不过鉴于患者数量相对较少，这一点有待未来更大规模的研究加以证实。
