Cardiogenic shock without flow-limiting angiographic coronary artery disease: (from the Should We Emergently Revascularize Occluded Coronary Arteries for Cardiogenic Shock Trial and Registry).
Cardiogenic shock without flow-limiting angiographic coronary artery disease: (from the Should We Emergently Revascularize Occluded Coronary Arteries for Cardiogenic Shock Trial and Registry).
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不伴有血流限制性冠状动脉造影疾病的心源性休克：（来自“我们是否应该紧急对闭塞冠状动脉进行血运重建以进行心源性休克试验和登记”）。
DOI：
10.1016/j.amjcard.2009.03.002
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发表时间：
2009
期刊：
影响因子：
--
通讯作者：
Hochman,JudithS
中科院分区：
文献类型：
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作者：
French,JohnK;Harkness,Shannon;Sleeper,Lynn;Wong,SChiu;Col,Jacques;Dzavik,Vladimir;White,HarveyD;Hochman,JudithS
当血栓形成发生在以前没有血流限制的病变处时，通常会发生心肌梗死。然而，在这种情况下，心源性休克并发急性心肌梗死的发展很少受到关注。将15例无血流限制性血管造影狭窄的心源性休克患者的特征与767例有≥1处狭窄的患者的特征进行比较，这些患者入组了心源性休克（SHOCK）试验和登记研究。与有≥1处血流限制性狭窄的患者相比，无血流限制性狭窄的患者在胸部X线检查中发生肺水肿的可能性更低（29% vs 62%，p = 0.008），并且是白色患者的可能性更低（53% vs 82%，p = 0.011），他们的肌酸激酶最高水平中位数更低（702 vs 2，731 U/L，p = 0.018）。对于SHOCK试验患者，≥1处血流限制性狭窄患者的1年生存率为49%，无血流限制性狭窄患者为71%（p = 0.268）。总之，无血流限制性狭窄的心源性休克患者具有不同的特征和潜在的疾病机制，他们不需要血运重建。
Myocardial infarction often develops when thrombosis occurs at lesions that have not previously been flow limiting. However, the development of cardiogenic shock complicating acute myocardial infarction in such circumstances has received little attention. The characteristics of 15 patients with cardiogenic shock who had no flow-limiting angiographic stenoses were compared with those of 767 patients with ≥1 stenosis who were enrolled in the Should We Emergently Revascularize Occluded Coronary Arteries for Cardiogenic Shock (SHOCK) trial and registry. Compared with patients with ≥1 flow-limiting stenosis, patients with no flow-limiting stenoses were less likely to have pulmonary edema on chest x-ray (29% vs 62%, p = 0.008) and to be white (53% vs 82%, p = 0.011), and they had lower median highest creatine kinase levels (702 vs 2,731 U/L, p = 0.018). For SHOCK trial patients, 1-year survival was 49% for patients with ≥1 flow-limiting stenosis and 71% for those with no flow-limiting stenoses (p = 0.268). In conclusion, patients with cardiogenic shock without flow-limiting stenosis have different characteristics, and potentially disease mechanisms, and they do not require revascularization.