Cardiogenic Shock After Acute Myocardial Infarction: A Review.
Cardiogenic Shock After Acute Myocardial Infarction: A Review.
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DOI：
10.1001/jama.2021.18323
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发表时间：
2021-11-09
影响因子：
120.7
通讯作者：
Rao, Sunil V.
中科院分区：
文献类型：
--
作者：
Samsky, Marc D.;Morrow, David A.;Proudfoot, Alastair G.;Hochman, Judith S.;Thiele, Holger;Rao, Sunil V.
在美国，心源性休克每年影响4万至5万人，是急性心肌梗死后住院死亡的主要原因。心肌梗死所致心源性休克患者的30天死亡率约为40%，1年死亡率接近50%。即刻梗死相关冠状动脉血运重建仍然是随机临床试验支持的唯一治疗急性心肌梗死相关心源性休克的方法。经皮冠状动脉介入治疗急性心肌梗死和心源性休克（元凶休克）临床试验表明，30天死亡或肾脏替代治疗的主要结局降低；罪魁祸首病变重建术组344例患者中有158例（45.9%），而多支经皮冠状动脉介入治疗组341例患者中有189例（55.4%）（相对危险度为0.83 [95% CI, 0.71-0.96]; P = 0.01）。尽管缺乏证明其益处的随机试验，经皮机械循环支持装置经常用于治疗急性心肌梗死后的心源性休克。高达10%的患者在急性心肌梗死后立即发生心源性休克，并与30天死亡率近40%和1年死亡率50%相关。目前的证据和临床实践指南支持梗死相关冠状动脉立即血运重建作为急性心肌梗死后心源性休克的主要治疗方法。
Cardiogenic shock affects between 40 000 and 50 000 people in the US per year and is the leading cause of in-hospital mortality following acute myocardial infarction. Thirty-day mortality for patients with cardiogenic shock due to myocardial infarction is approximately 40%, and 1-year mortality approaches 50%. Immediate revascularization of the infarct-related coronary artery remains the only treatment for cardiogenic shock associated with acute myocardial infarction supported by randomized clinical trials. The Percutaneous Coronary Intervention Strategies with Acute Myocardial Infarction and Cardiogenic Shock (CULPRIT-SHOCK) clinical trial demonstrated a reduction in the primary outcome of 30-day death or kidney replacement therapy; 158 of 344 patients (45.9%) in the culprit lesion revascularization-only group compared with 189 of 341 patients (55.4%) in the multivessel percutaneous coronary intervention group (relative risk, 0.83 [95% CI, 0.71-0.96]; P = .01). Despite a lack of randomized trials demonstrating benefit, percutaneous mechanical circulatory support devices are frequently used to manage cardiogenic shock following acute myocardial infarction. Cardiogenic shock occurs in up to 10% of patients immediately following acute myocardial infarction and is associated with mortality rates of nearly 40% at 30 days and 50% at 1 year. Current evidence and clinical practice guidelines support immediate revascularization of the infarct-related coronary artery as the primary therapy for cardiogenic shock following acute myocardial infarction.
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影响因子：
120.7
作者：
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发表时间：
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影响因子：
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