急性心肌梗死相关心源性休克患者关键管理策略的依从性及死亡率报告：中国心血管疾病改善项目-急性冠状动脉综合征的研究结果

Report on the adherence to key management strategies and mortality rates in patients with acute myocardial infarction-related cardiogenic shock: Findings from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome project.

作者信息

Liu Yuwei, Li Chenglong, Wang Liangshan, Hao Xing, Du Zhongtao, Wang Hong, Hou Xiaotong

机构信息

Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

出版信息

Int J Cardiol. 2025 Dec 1;440:133666. doi: 10.1016/j.ijcard.2025.133666. Epub 2025 Jul 26.

DOI:10.1016/j.ijcard.2025.133666

PMID:40720993

Abstract

BACKGROUND

Acute myocardial infarction-related cardiogenic shock (AMI-CS) is a severe complication with high in-hospital mortality. However, real-world data on AMI-CS care are limited. This study aimed to evaluate the adherence to management strategies for AMI-CS.

METHODS

Using data from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) Project, we assessed adherence to twelve key management strategies based on AMI-CS statements and AMI guidelines as well as overall treatment adherence, with a focus on both ST-segment elevation myocardial infarction (STEMI)-CS and non-ST-segment elevation myocardial infarction (NSTEMI)-CS. We also examined hospital-level variations in each management strategy.

RESULTS

A total of 2726 AMI-CS patients were included. High adherence was observed in cardiac troponin measurement (94.6 %), dual antiplatelet therapy (DAPT) administration at hospital arrival (92.4 %), DAPT (90.8 %) and statin (95.7 %) prescriptions at discharge, and smoking cessation counseling (89.9 %). However, adherence to risk stratification for NSTEMI-CS patients (59.5 %), primary percutaneous coronary intervention (PCI) within 90 min (39.5 %), fibrinolysis therapy within 30 min for STEMI-CS patients (20.2 %), and β-blocker (62.2 %) or angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) (45.3 %) prescriptions at discharge was significantly lower. Furthermore, regarding treatments not recommended during the acute phase, 69.8 % of patients did not receive β-blockers, and 77.4 % did not receive ACEI/ARBs upon admission. Overall, 9.2 % of AMI-CS patients received comprehensive care, with 10.2 % of STEMI-CS patients and 3.6 % of NSTEMI-CS patients receiving it.

CONCLUSION

A significant gap exists between guideline recommendations and clinical practice, with only 10 % of AMI-CS patients receiving high-quality care. The quality of care varied substantially across hospitals.

摘要

背景

急性心肌梗死相关的心源性休克（AMI-CS）是一种严重并发症，院内死亡率很高。然而，关于AMI-CS治疗的真实世界数据有限。本研究旨在评估对AMI-CS管理策略的依从性。

方法

利用中国心血管疾病改善项目-急性冠状动脉综合征（CCC-ACS）的数据，我们根据AMI-CS声明和AMI指南评估了对12项关键管理策略的依从性以及总体治疗依从性，重点关注ST段抬高型心肌梗死（STEMI）-CS和非ST段抬高型心肌梗死（NSTEMI）-CS。我们还研究了各管理策略在医院层面的差异。

结果

共纳入2726例AMI-CS患者。肌钙蛋白检测的依从性较高（94.6%），入院时双联抗血小板治疗（DAPT）的给药依从性（92.4%）、出院时DAPT（90.8%）和他汀类药物（95.7%）的处方依从性以及戒烟咨询的依从性（89.9%）均较高。然而，NSTEMI-CS患者风险分层的依从性（59.5%）、90分钟内进行直接经皮冠状动脉介入治疗（PCI）的依从性（39.5%）、STEMI-CS患者30分钟内进行溶栓治疗的依从性（20.2%）以及出院时β受体阻滞剂（62.2%）或血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（ACEI/ARB）（45.3%）的处方依从性显著较低。此外，对于急性期不推荐的治疗，69.8%的患者入院时未接受β受体阻滞剂治疗，77.4%的患者未接受ACEI/ARB治疗。总体而言，9.2%的AMI-CS患者接受了综合治疗，其中10.2%的STEMI-CS患者和3.6%的NSTEMI-CS患者接受了综合治疗。