Moscucci M, Bates E R
Division of Cardiology, University of Michigan, Ann Arbor, USA.
Cardiol Clin. 1995 Aug;13(3):391-406.
Despite advancements in the pharmacologic treatment of acute myocardial infarction and the introduction of mechanical hemodynamic support, in-hospital mortality rates for cardiogenic shock have remained between 70% and 80%. In addition, the proven beneficial effects of thrombolytic therapy in reducing mortality in acute myocardial infarction have not been paralleled by similar results in cardiogenic shock. Emergency revascularization appears to be the only intervention that may modify the prognosis of cardiogenic shock. Because the absence of controlled data, however, final conclusions cannot yet be drawn. Two ongoing randomized clinical trials will try to answer the unsolved issues. In the multicenter international SHOCK trial (Should We Revascularize Occluded Coronaries for Cardiogenic Shock), patients are being randomized to PTCA or conservative treatment, with mortality as the primary end point. A similar end point will be evaluated in the Swiss Multicenter Study of Angioplasty for Shock following Myocardial Infarction (SMASH) trial. It is hoped that these two randomized trials will be able to prove the value of PTCA in cardiogenic shock and identify the subset of patients most likely to benefit from such treatment.
尽管急性心肌梗死的药物治疗取得了进展，并且引入了机械血流动力学支持，但心源性休克的院内死亡率仍在70%至80%之间。此外，溶栓治疗在降低急性心肌梗死死亡率方面已证实的有益效果，在心源性休克中并未得到类似的结果。紧急血运重建似乎是唯一可能改变心源性休克预后的干预措施。然而，由于缺乏对照数据，尚未能得出最终结论。两项正在进行的随机临床试验将试图回答这些未解决的问题。在多中心国际SHOCK试验（心源性休克时我们是否应使闭塞冠状动脉再通）中，患者被随机分为接受经皮冠状动脉腔内血管成形术（PTCA）或保守治疗，以死亡率作为主要终点。在瑞士心肌梗死后休克血管成形术多中心研究（SMASH）试验中将评估类似的终点。希望这两项随机试验能够证明PTCA在心源性休克中的价值，并确定最有可能从这种治疗中获益的患者亚组。
