心力衰竭和急性心肌梗死相关心源性休克患者使用股动脉主动脉内球囊反搏的结果

Outcomes With Femoral IABP in Heart Failure and Acute Myocardial Infarction-Related Cardiogenic Shock.

作者信息

Garan Arthur Reshad, Bhimaraj Arvind, Kataria Rachna, Rali Aniket, Grandin E Wilson, Delgado Alvaro A, Kochar Ajar, Li Borui, Kanwar Manreet K, Sinha Shashank S, Hernandez-Montfort Jaime, Abraham Jacob, Li Song, Arias-Mendoza Alexandra, Bezerra Hiram, Blumer Vanessa, Chiang I-Hui, Farr Mary Jane, Fried Justin, Gage Ann, Hall Shelley, Hickey Gavin W, Ilonze Onyedika, Guglin Maya, Khalife Wissam, Kim J U, Lundgren Scott, Marbach Jeffrey, Mishkin Joseph, Nathan Sandeep, Pahuja Mohit, Schwartzman Andrew, Ton VAN-Khue, Vishnevsky Oleg Alec, Vorovich Esther, Wald Joyce, Zweck Elric, Kong Qiuyue, Sangal Paavni, Walec Karol D, Zazzali Peter, Harwani Neil M, John Kevin, Mahr Claudius, Burkhoff Daniel, Kapur Navin K

机构信息

Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.

Methodist DeBakey Cardiology Associates, Houston Methodist Hospital, Houston, TX.

出版信息

J Card Fail. 2025 May 9. doi: 10.1016/j.cardfail.2025.04.007.

DOI:10.1016/j.cardfail.2025.04.007

PMID:40348328

Abstract

BACKGROUND

Intra-aortic balloon pump (IABP) insertion has not been shown to improve mortality rates in acute myocardial infarction-related cardiogenic shock (AMI-CS) but is increasingly used in heart failure-related cardiogenic shock (HF-CS).

OBJECTIVE

We sought to compare IABP-related outcomes in patients with HF-CS and AMI-CS.

METHODS

The Cardiogenic Shock Working Group registry was queried for patients with CS receiving femoral IABPs as the first temporary mechanical circulatory support (tMCS) device. Patients were divided into those with AMI-CS or HF-CS and were excluded if they received the IABP in conjunction with venoarterial extracorporeal membrane oxygenation (VA-ECMO) or another device concomitantly. Outcomes, including rates of native heart survival (NHS) (ie, weaned from IABP and discharged), heart replacement therapy (HRT) (ie, bridge to durable left ventricular assist device or heart transplant), need for another tMCS device, and death, were recorded and compared between the 2 cohorts.

RESULTS

In total, 886 patients were supported by IABPs as the first tMCS device; of these, 407 (45.6%) had HF-CS and 384 (43.3%) had AMI-CS. Those with HF-CS were younger but had higher burdens of cardiovascular comorbidities than those with AMI-CS. Among the HF-CS cohort, 33.2% had NHS, and 26.7% were bridged to HRT without another tMCS device. In the AMI-CS cohort, 43.4% had NHS and 2.1% were bridged to HRT without another tMCS device. Mortality rates were higher in AMI-CS group (36.4% vs 20.6%; P < 0.001). Complication rates were higher in those with AMI-CS and in those needing another tMCS device.

CONCLUSION

Patients with HF-CS were more likely to have a favorable outcome with IABPs than those with AMI-CS.

摘要

背景

主动脉内球囊反搏（IABP）置入术尚未被证明能提高急性心肌梗死相关心源性休克（AMI-CS）的死亡率，但在心力衰竭相关心源性休克（HF-CS）中应用越来越广泛。

目的

我们试图比较HF-CS和AMI-CS患者IABP相关的结局。

方法

查询心源性休克工作组登记处中接受股动脉IABP作为首个临时机械循环支持（tMCS）装置的CS患者。患者分为AMI-CS或HF-CS患者，如果他们同时接受IABP与静脉-动脉体外膜肺氧合（VA-ECMO）或其他装置，则被排除。记录并比较两组患者的结局，包括自体心脏存活（NHS）率（即撤离IABP并出院）、心脏替代治疗（HRT）率（即过渡到持久左心室辅助装置或心脏移植）、是否需要另一个tMCS装置以及死亡率。

结果

共有886例患者接受IABP作为首个tMCS装置；其中，407例（45.6%）为HF-CS患者，384例（43.3%）为AMI-CS患者。HF-CS患者较年轻，但心血管合并症负担比AMI-CS患者高。在HF-CS队列中，33.2%实现了NHS，26.7%在未使用另一个tMCS装置的情况下过渡到HRT。在AMI-CS队列中，则分别为43.4%和2.1%。AMI-CS组的死亡率更高（36.4%对20.6%；P<0.001）。AMI-CS患者和需要另一个tMCS装置的患者并发症发生率更高。