Mortality after emergent percutaneous coronary intervention in cardiogenic shock secondary to acute myocardial infarction and usefulness of a mortality prediction model
Mortality after emergent percutaneous coronary intervention in cardiogenic shock secondary to acute myocardial infarction and usefulness of a mortality prediction model
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DOI：
10.1016/j.amjcard.2005.02.040
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发表时间：
2005-07-01
影响因子：
2.8
通讯作者：
Weintraub, WS
中科院分区：
文献类型：
--
作者：
Klein, LW;Shaw, RE;Weintraub, WS
虽然经皮冠状动脉介入治疗（PCI）在心源性休克的情况下有很高的住院死亡率，但它已被证明可以降低某些亚组的死亡率。预测心源性休克PCI术后住院死亡率的变量的身份和相对重要性是不确定的。因此，我们检查了美国心脏病学会-国家心血管数据登记处（ACC-NCDR）从1998年到2002年收集的1,300,000例患者的数据，并评估了483例因心源性休克而连续接受急诊PCI治疗的患者的结果。患者平均年龄为65±13岁，男性居多（61%）。在急性心肌梗死后心源性休克的情况下，所有患者都接受了急诊/救助性PCI治疗。平均左室射血分数为30±16%。64%的患者放置了支架，26%的患者使用了溶栓药物。尽管79%的患者在血管造影中PCI成功，但住院死亡率为59.4%。PCI术后住院时间为7.2±8天。使用所有可用变量进行Logistic回归，确定了6个多因素死亡预测因素：年龄（比值比[OR] 2.34, 95%可信区间[CI] 1.68至3.28,p < 0.001），女性性别（比值比[OR] 1.55, 95% CI 1.00至2.41,p < 0.001），基线肾功能不全(肌酐> 2.0 mg/dl；OR 4.69, 95% Cl 1.96 ~ 11.23, p < 0.001)，左前降支完全闭塞（OR 1.99, 95%可信区间1.28 ~ 3.09,p < 0.01），未使用支架（OR 2.55, 95% CI 1.63 ~ 3.96, p < 0.01）， PCI期间未使用糖蛋白II/IIIa抑制剂（OR 1.96, 95% CI 1.30 ~ 2.98, p < 0.01）。在第二次分析中，仅使用临床医生在初始表现时已知的变量，性别、年龄、肾功能不全和左冠状动脉前降支完全闭塞是显著的。总之，对ACC-NCDR中出现心源性休克的急性心肌梗死患者进行急诊PCI治疗的分析显示，当尝试PCI治疗时，住院死亡率接近60%。(c) 2005爱思唯尔公司版权所有。
Although percutaneous coronary intervention (PCI) in the setting of cardiogenic shock has a high in-hospital mortality rate, it has been shown to decrease the mortality rate in certain subgroups. The identity and relative importance of variables that are predictive of in-hospital mortality rate after PCI for cardiogenic shock are uncertain. Accordingly, we examined data of > 300,000 patients in the American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR) that were collected from 1998 to 2002 and evaluated the outcomes in 483 consecutive patients who underwent emergency PCI for cardiogenic shock. Patients' mean age was 65 +/- 13 years, with men predominating (61%). All underwent emergency/salvage PCI in the setting of cardiogenic shock after acute myocardial infarction. Mean left ventricular ejection fraction was 30 +/- 16%. Stents were placed in 64% of patients, and thrombolytic agents were administered in 26%. Although PCI was angiographically successful in 79% of patients, the in-hospital mortality rate was 59.4%. Length of stay after PCI was 7.2 +/- 8 days. Logistic regression using all available variables identified 6 multivariate predictors of death: age (odds ratio [OR] 2.34, 95% confidence interval [CI] 1.68 to 3.28, p < 0.001) for each 10-year increment, female gender (OR 1.55, 95% CI 1.00 to 2.41, p < 0.001), baseline renal insufficiency (creatinine > 2.0 mg/dl; OR 4.69, 95% Cl 1.96 to 11.23, p < 0.001), total occlusion in the left anterior descending artery (OR 1.99, 95% confidence interval 1.28 to 3.09, p < 0.01), no stent used (OR 2.55, 95% CI 1.63 to 3.96, p < 0.01), and no glycoprotein II/IIIa inhibitor used during PCI (OR 1.96, 95% CI 1.30 to 2.98, p < 0.01). In a second analysis using only variables known to the clinician at the time of initial presentation, gender, age, renal insufficiency, and total occlusion of the left anterior descending coronary artery were significant. In conclusion, analysis of patients from the ACC-NCDR who underwent emergency PCI for acute myocardial infarction in the presence of cardiogenic shock shows an in-hospital mortality rate of similar to 60% when PCI is attempted. (c) 2005 Elsevier Inc. All rights reserved.