Benefit and harm of intravenous vasodilators across the clinical profile spectrum in acute cardiogenic pulmonary oedema patients
Benefit and harm of intravenous vasodilators across the clinical profile spectrum in acute cardiogenic pulmonary oedema patients
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DOI：
10.1177/2048872619891075
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发表时间：
2020-01-29
影响因子：
4.1
通讯作者：
Takayama, Morimasa
中科院分区：
文献类型：
--
作者：
Shiraishi, Yasuyuki;Kohsaka, Shun;Takayama, Morimasa
背景资料：由于缺乏高质量、大规模的数据表明静脉血管扩张剂在急性心力衰竭中的作用具有明确的死亡率获益，因此无法得出确切的结论。我们的目的是调查静脉血管扩张剂和急性心力衰竭患者的临床结局之间的关系，特别关注患者的情况和血管扩张剂的类型。研究方法：2009年至2015年期间，26，212名因急性心力衰竭而紧急住院的连续患者的数据来自政府资助的多中心数据登记系统。使用多重插补计算倾向评分，并在使用和未使用血管扩张剂的患者之间进行1：1匹配。主要终点为住院死亡率。结果如下：在倾向评分匹配后直接比较血管扩张剂组和非血管扩张剂组，两组之间的住院死亡率（分别为7.5%和8.8%; P=0.098）或重症监护室/心血管监护室住院时间和住院时间无显著差异。然而，血管扩张剂类型的基线收缩压存在显著差异;在收缩压较高的患者和入院时无房颤的患者中观察到血管扩张剂使用对住院死亡率的有利影响。此外，与硝酸盐相比，卡培立肽（利钠肽制剂）的使用与不良结局显著相关，尤其是在中等收缩压患者中。结论：在急性心力衰竭患者中，血管扩张剂的使用并不普遍与改善住院结局相关;相反，其效果取决于个体临床表现：收缩压较高且无房颤的患者似乎从血管扩张剂中获益最大。
Background: The absence of high quality, large-scale data that indicates definitive mortality benefits does not allow for firm conclusions on the role of intravenous vasodilators in acute heart failure. We aimed to investigate the associations between intravenous vasodilators and clinical outcomes in acute heart failure patients, with a specific focus on patient profiles and type of vasodilators. Methods: Data of 26,212 consecutive patients urgently hospitalised for a primary diagnosis of acute heart failure between 2009 and 2015 were extracted from a government-funded multicentre data registration system. Propensity scores were calculated with multiple imputations and 1:1 matching performed between patients with and without vasodilator use. The primary endpoint was inhospital mortality. Results: On direct comparison of the vasodilator and non-vasodilator groups after propensity score matching, there were no significant differences in the inhospital mortality rates (7.5% vs. 8.8%, respectively; P=0.098) or length of intensive/cardiovascular care unit stay and hospital stay between the two groups. However, there was a substantial difference in baseline systolic blood pressure by vasodilator type; favourable impacts of vasodilator use on inhospital mortality were observed among patients who had higher systolic blood pressures and those who had no atrial fibrillation on admission. Furthermore, when compared to nitrates, the use of carperitide (natriuretic peptide agent) was significantly associated with worse outcomes, especially in patients with intermediate systolic blood pressures. Conclusions: In acute heart failure patients, vasodilator use was not universally associated with improved inhospital outcomes; rather, its effect depended on individual clinical presentation: patients with higher systolic blood pressure and no atrial fibrillation seemed to benefit maximally from vasodilators.