Rapid complete reversal of systemic hypoperfusion after intra-aortic balloon pump counterpulsation and survival in cardiogenic shock complicating an acute myocardial infarction.
Rapid complete reversal of systemic hypoperfusion after intra-aortic balloon pump counterpulsation and survival in cardiogenic shock complicating an acute myocardial infarction.
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DOI：
10.1016/j.ahj.2011.04.025
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发表时间：
2011-08
影响因子：
4.8
通讯作者：
Hochman, Judith S.
中科院分区：
文献类型：
--
作者：
Ramanathan, Krishnan;Farkouh, Michael E.;Cosmi, John E.;French, John K.;Harkness, Shannon M.;Dzavik, Vladimir;Sleeper, Lynn A.;Hochman, Judith S.
在心源性休克(CS)合并急性心肌梗死的患者中，紧急血运重建策略与最初的药物稳定策略相比可以提高存活率。主动脉内球囊反搏(IABC)为CS患者提供血流动力学支持，促进冠状动脉造影术和血运重建。我们从休克试验(n=185)和登记(n=314)中评估了499名有全身低灌流状态记录的患者，作为对IABC的早期反应，以确定IABC 30分钟后全身低灌流迅速完全逆转(CRH)与30天和1年死亡率之间的关系。在所有患者中，CRH与较低的30天死亡率(45%比78%，p<；0.001)高度相关。在休克试验中，在接受ERV和IMS的患者中，在开始IABC后，有CRH的患者30天死亡率分别为26%和29%，而没有CRH的患者的30d死亡率分别为61%和81%。相应的1年死亡率，ERV组为35%比52%，IMS组为69%比87%(交互作用p≥在两个时间点均为0.25)。在调整了重要的预后相关因素(左心室射血分数、年龄和随机分组为ERV)后，CRH和30天死亡率(优势比0.18；95%可信区间0.08-0.42，p<；0.001)和1年死亡率(优势比0.28；95%可信区间0.12-0.67，p<；0.001)之间仍然存在显著的相关性。在CS患者中，无论紧急血管重建术如何，开始IABC后CRH与改善30天和1年存活率独立相关。在CS患者中，CRH合并IABC是一个重要的早期预后特征。
In patients with cardiogenic shock (CS) complicating an acute myocardial infarction, a strategy of emergency revascularization vs. initial medical stabilization improves survival. Intra-aortic balloon counterpulsation (IABC) provides hemodynamic support and facilitates coronary angiography and revascularization in CS patients. We evaluated 499 patients with record of systemic hypoperfusion status, as an early response to IABC from the SHOCK Trial (n=185) and Registry (n=314) to determine the association between rapid complete reversal of systemic hypoperfusion following 30 minutes of IABC(CRH)and 30-day and 1-year mortality. CRH was highly associated with lower 30-day mortality (45% vs. 78%, p<0.001) in all patients. In the SHOCK Trial, among patients assigned to ERV vs. IMS, 30-day mortality was 26% vs. 29% with CRH, and 61% vs. 81% respectively without CRH, after commencing IABC. The corresponding 1-year mortality rates were 35% vs. 52% for ERV and 69% vs. 87% for IMS (interaction p ≥ 0.25 at both time points). After adjusting for important correlates of outcome (LV ejection fraction, age, and randomization to ERV) a significant association remained between CRH and 30-day mortality (odds ratio 0.18; 95% CI 0.08–0.42, p<0.001) and 1-year mortality (odds ratio 0.28; 95% CI 0.12–0.67, p<0.001). In CS patients, CRH after commencing IABC was independently associated with improved 30-day and 1-year survival regardless of emergency revascularization. In CS patients, CRH with IABC is an important early prognostic feature.
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影响因子：
158.5
作者：
Hochman, JS;Sleeper, LA;LeJemtel, TH
通讯作者：
LeJemtel, TH
影响因子：
2.8
作者：
URSCHEL, CW;EBER, L;SONNENBLICK, E
通讯作者：
SONNENBLICK, E
DOI：
10.1016/s0735-1097(00)00875-5
发表时间：
2000-09-01
影响因子：
24
作者：
Sanborn, TA;Sleeper, LA;Hochman, JS
通讯作者：
Hochman, JS
DOI：
10.1016/s0735-1097(01)01553-4
发表时间：
2001-11-01
影响因子：
24
作者：
Ferguson, JJ;Cohen, M;Ohman, EM
通讯作者：
Ohman, EM
影响因子：
24
作者：
Singh, Mandeep;White, Jennifer;Holmes, David R., Jr.
通讯作者：
Holmes, David R., Jr.