Long-term outcome and its predictors among patients with ST-Segment elevation myocardial infarction complicated by shock: Insights from the GUSTO-I trial
Long-term outcome and its predictors among patients with ST-Segment elevation myocardial infarction complicated by shock: Insights from the GUSTO-I trial
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DOI：
10.1016/j.jacc.2007.04.101
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发表时间：
2007-10-30
影响因子：
24
通讯作者：
Holmes, David R., Jr.
中科院分区：
文献类型：
--
作者：
Singh, Mandeep;White, Jennifer;Holmes, David R., Jr.
目的本研究旨在评估心源性休克患者30天存活者的长期预后，并确定其预测因素。背景资料显示，心源性休克患者的住院和30天死亡率较高，但存活超过30天的患者的数据很少。方法我们分析了基线、住院时间、结果在美国登记的22,883例患者中，1,891例(8.3%)发生休克，1,891例(8.3%)；953例(50.4%)存活30天，527例(27.8%)存活1年。在20992名没有休克的美国患者中，20360名(96.9%)存活了30天，14131名(67.3%)存活了11年。在第一年后，每年有2%到4%的患者死亡，无论他们是否有心源性休克。使用COX比例风险模型，我们能够根据基线人口统计学和住院并发症预测所有美国GUSTO-I 30天幸存者的长期死亡率。最强的预测因素是糖尿病、心源性休克、高血压、既往心肌梗死、现在吸烟、前壁梗死、较高的Killip分级、较高的心率和年龄；75岁的患者风险最高。住院期间的经皮血管重建术与死亡风险降低有关。结论在STEMI后存活30天的心源性休克患者中，2%~4%的年死亡率与未发生休克的患者相似。
Objectives This study sought to assess long-term outcome and determine its predictors among 30-day survivors of cardiogenic shock.Background Patients with cardiogenic shock have high in-hospital and 30-day mortality, but there are little data about those who survive beyond 30 days.Methods We analyzed baseline, in-hospital, and survival data from patients in the U.S. with ST-segment elevation myocardial infarction (STEM[) and cardiogenic shock enrolled in the GUSTO (Global Utilization of Streptokinase and Tissue-Type Plasminogen Activator for Occluded Coronary Arteries)-l trial and compared them with patients in the same trial who did not have shock.Results Of 22,883 patients enrolled in the U.S., shock occurred in 1,891 (8.3%); 953 (50.4%) survived 30 days and 527 (27.8%) survived il years. Of 20,992 U.S. patients without shock, 20,360 (96.9%) survived 30 days and 14,131 (67.3%) survived :11 years. After the first year, 2% to 4% of patients died each year regardless of whether they had cardiogenic shock. Using Cox proportional hazards models, we were able to predict long-term mortality in all U.S. GUSTO-I 30-day survivors from their baseline demographics and in-hospital complications. The strongest predictors were diabetes mellitus, cardiogenic shock, hypertension, previous myocardial infarction, current smoking, anterior infarct, higher Killip class, higher heart rate, and older age; patients >75 years were at highest risk. Percutaneous revascularization during the index hospitalization was associated with a reduced risk of death.Conclusions Among patients with cardiogenic shock who survive 30 days after STEMI, annual mortality rates of 2% to 4% approximate those of patients without shock.