Functional status and quality of life after emergency revascularization for cardiogenic shock complicating acute myocardial infarction
Functional status and quality of life after emergency revascularization for cardiogenic shock complicating acute myocardial infarction
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DOI：
10.1016/j.jacc.2005.01.061
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发表时间：
2005-07-19
影响因子：
24
通讯作者：
Hochman, JS
中科院分区：
文献类型：
--
作者：
Sleeper, LA;Ramanathan, K;Hochman, JS
我们的目的是描述心源性休克幸存者的功能状态，确定心源性休克的相关因素，并比较随机分配到紧急血运重建（ERV）和初始医疗稳定（IMS）治疗的患者的总体生活质量和功能状态。历史上，心源性休克合并急性心肌梗死（MI）患者的住院生存率一直很低。休克幸存者是从危重状态抢救出来的，他们后来的功能状态没有很好的记录。心脏源性休克（shocK）的冠状动脉闭塞紧急血运重建试验显示，与IMS相比，ERV术后一年生存率显著提高。方法休克试验幸存者在出院后2周、心肌梗死后6个月和12个月完成访谈。功能状态评估包括生活质量多维指数和纽约心脏协会（NYHA）充血性心力衰竭功能等级。结果：87%的SHOCK试验1年存活者NYHA功能正常。I类或II类。在出院后两周至心肌梗死后一年内，两组患者的改善情况相似（总体为18%），但较少患者保持稳定（44%对71%），IMS组与ERV组相比，更多患者恶化或死亡（34%对15%）。分配到ERV是一年时预后的唯一独立预测因子。结论：尽管ERV术后1年死亡率仍然很高（54%），但大多数幸存者的功能状态良好。ERV患者的恶化率低于IMS患者。接受ERV的休克患者的恢复水平与非心源性休克接受择期血运重建术的历史对照组相似。(c) 2005年由美国心脏病学会基金会提供。
OBJECTIVES Our goal was to describe the functional status of cardiogenic shock survivors, identify the correlates of cardiogenic shock, and compare global quality of life and functional status of patients randomly assigned to treatment with emergency revascularization (ERV) versus initial medical stabilization (IMS).BACKGROUND Historically, the hospital survival rate of patients with cardiogenic shock complicating acute myocardial infarction (MI) has been very low. Shock survivors are salvaged from a critically ill state, and their later functional status is not well documented. The SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK (SHOCK) trial showed significantly improved one-year survival after ERV compared with IMS.METHODS The SHOCK trial survivors completed interviews at 2 weeks after discharge and at 6 and 12 months after MI. Functional status assessment included the Multidimensional Index of Life Quality and New York Heart Association (NYHA) congestive heart failure functional class.RESULTS Eighty-seven percent of one-year survivors of the SHOCK trial were in NYHA functional. class I or II. Between two weeks after discharge and one year after MI, improvement was similar in the two treatment groups (18% overall), but fewer patients remained stable (44% vs. 71%), and more patients worsened or died (34% vs. 15%) in the IMS group compared with those assigned to ERV. Assignment to ERV was the only independent predictor of outcome at one year.CONCLUSIONS Although one-year mortality after ERV is still high (54%), most survivors have good functional status. The ERV patients have a lower rate of deterioration than IMS patients. The level of recovery for shock patients undergoing ERV is similar to that of historical controls not in cardiogenic shock undergoing elective revascularization. (c) 2005 by the American College of Cardiology Foundation.