Schupp Tobias, Thiele Holger, Rassaf Tienush, Mahabadi Amir Abbas, Lehmann Ralf, Eitel Ingo, Skurk Carsten, Clemmensen Peter, Hennersdorf Marcus, Voigt Ingo, Linke Axel, Tigges Eike, Nordbeck Peter, Jung Christian, Lauten Philipp, Feistritzer Hans-Josef, Buske Maria, Pöss Janine, Ouarrak Taoufik, Schneider Steffen, Behnes Michael, Duerschmied Daniel, Desch Steffen, Freund Anne, Zeymer Uwe, Akin Ibrahim
Department of Cardiology, Angiology, Hemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
Heart Center Leipzig at Leipzig University and Leipzig Heart Science, Leipzig, Germany.
Eur Heart J Acute Cardiovasc Care. 2025 Feb 20;14(2):59-70. doi: 10.1093/ehjacc/zuae148.
The impact of systemic inflammation in acute myocardial infarction complicated by cardiogenic shock (AMI-CS) is still a matter of debate. The present ECLS-SHOCK sub-study investigates the association of C-reactive protein (CRP) levels with short-term outcomes in patients with AMI-CS.
Patients with AMI-CS enrolled in the multicentre, randomized ECLS-SHOCK trial between 2019 and 2022 were included. The prognostic impact of CRP levels on admission, as well as the effect of extracorporeal life support (ECLS), stratified by CRP levels, was tested with regard to the primary endpoint of 30-day all-cause mortality. In 371 patients with AMI-CS and available CRP level on baseline, the median CRP level was 18.0 mg/L. Patients with CRP levels in the highest tertile were older and less often resuscitated from cardiac arrest. The highest tertile (i.e. CRP >61.0 mg/L) was associated with an increased risk of 30-day all-cause mortality compared with patients with lower CRP levels (lowest tertile: ≤5.0 mg/L) [adjusted odds ratio: 3.54; 95% confidence interval (CI) 1.88-6.68; P = 0.001]. The use of ECLS did not reduce 30-day all-cause mortality, irrespective of CRP levels on admission. The additional inclusion of CRP to the IABP-SHOCK II score was associated with a slight improvement of the prediction of 30-days all-cause mortality (area under the curve: 0.74; 95% CI 0.68-0.79).
Higher CRP levels were independently associated with the risk of 30-day all-cause mortality in AMI-CS. The additional inclusion of CRP to a validated CS risk score may further improve the prediction of short-term prognosis.
全身性炎症在急性心肌梗死合并心源性休克（AMI-CS）中的影响仍存在争议。目前的体外膜肺氧合-休克（ECLS-SHOCK）子研究调查了C反应蛋白（CRP）水平与AMI-CS患者短期预后的关联。
纳入2019年至2022年期间参与多中心随机ECLS-SHOCK试验的AMI-CS患者。以30天全因死亡率作为主要终点，测试了入院时CRP水平的预后影响以及按CRP水平分层的体外生命支持（ECLS）的效果。在371例基线时可获得CRP水平的AMI-CS患者中，CRP水平中位数为18.0mg/L。CRP水平处于最高三分位数的患者年龄较大，心脏骤停后复苏的频率较低。与CRP水平较低（最低三分位数：≤5.0mg/L）的患者相比，最高三分位数（即CRP>61.0mg/L）与30天全因死亡率风险增加相关[调整优势比：3.54；95%置信区间（CI）1.88-6.68；P=0.001]。无论入院时CRP水平如何，使用ECLS均未降低30天全因死亡率。将CRP纳入IABP-SHOCK II评分可使30天全因死亡率预测略有改善（曲线下面积：0.74；95%CI 0.68-0.79）。
较高的CRP水平与AMI-CS患者30天全因死亡率风险独立相关。将CRP纳入经过验证的CS风险评分可能会进一步改善短期预后的预测。
