Percutaneous coronary intervention for cardiogenic shock in the SHOCK Trial Registry.
Percutaneous coronary intervention for cardiogenic shock in the SHOCK Trial Registry.
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DOI：
10.1067/mhj.2001.115294
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发表时间：
2001-06
影响因子：
4.8
通讯作者：
J. Webb;T. Sanborn;L. Sleeper;R. Carere;C. Buller;J. Slater;K. Baran;P. T. Koller;J. Talley;M. Porway;J. Hochman
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文献类型：
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作者：
J. Webb;T. Sanborn;L. Sleeper;R. Carere;C. Buller;J. Slater;K. Baran;P. T. Koller;J. Talley;M. Porway;J. Hochman
SHOCK登记研究前瞻性地纳入了36个多国中心的心源性休克合并急性心肌梗死患者。方法884例心源性休克患者均以左心室泵衰竭为主。其中，276例在休克发作后接受了经皮冠状动脉介入治疗（PCI），是本报告的主题。结果大多数（78%）接受血管造影术的患者有多支血管病变。随着病变动脉数量从1条增加到3条，死亡率从34.2%上升到51.2%。接受PCI的患者的院内死亡率低于接受药物治疗的患者（46.4% vs 78.0%，P <0.001），即使在调整了患者差异和生存偏倚后（P = 0.037）。PCI前，76.3%的罪犯动脉闭塞（心肌梗死溶栓0级或1级血流）。PCI术后，如果再灌注完全（3级血流），住院死亡率为33.3%，不完全再灌注（2级血流）为50.0%，无再灌注（0级或1级血流）为85.7%（P <0.001）。结论：急性心肌梗死合并心源性休克患者的前瞻性、多中心登记研究与经皮冠状动脉血运重建术降低死亡率的结果一致。冠状动脉通畅性是一个重要的预测结果。促进早期和快速再灌注的措施对于改善心源性休克相关的不良结局至关重要。
BACKGROUND The SHOCK Registry prospectively enrolled patients with cardiogenic shock complicating acute myocardial infarction in 36 multinational centers. METHODS Cardiogenic shock was predominantly attributable to left ventricular pump failure in 884 patients. Of these, 276 underwent percutaneous coronary intervention (PCI) after shock onset and are the subject of this report. RESULTS The majority (78%) of patients undergoing angiography had multivessel disease. As the number of diseased arteries rose from 1 to 3, mortality rates rose from 34.2% to 51.2%. Patients who underwent PCI had lower in-hospital mortality rates than did patients treated medically (46.4% vs 78.0%, P < .001), even after adjustment for patient differences and survival bias (P = .037). Before PCI, the culprit artery was occluded (Thrombolysis In Myocardial Infarction grade 0 or 1 flow) in 76.3%. After PCI, the in-hospital mortality rate was 33.3% if reperfusion was complete (grade 3 flow), 50.0% with incomplete reperfusion (grade 2 flow), and 85.7% with absent reperfusion (grade 0 or 1 flow) (P < .001). CONCLUSIONS This prospective, multicenter registry of patients with acute myocardial infarction complicated by cardiogenic shock is consistent with a reduction in mortality rates as the result of percutaneous coronary revascularization. Coronary artery patency was an important predictor of outcome. Measures to promote early and rapid reperfusion appear critically important in improving the otherwise poor outcome associated with cardiogenic shock.