Cardiogenic shock caused by right ventricular infarction - A report from the SHOCK registry
Cardiogenic shock caused by right ventricular infarction - A report from the SHOCK registry
复制标题
DOI：
10.1016/s0735-1097(03)00120-7
复制
发表时间：
2003-04-16
影响因子：
24
通讯作者：
Hochman, JS
中科院分区：
文献类型：
--
作者：
Jacobs, AK;Leopold, JA;Hochman, JS
本研究的目的是确定急性心肌梗死（MI）合并心源性休克患者的特征和预后，这些患者主要是由于右心室（RV）梗死所致。右心室梗死对心源性休克死亡率的影响尚不清楚。方法我们评估了933例因右心室占优势而发生心源性休克的患者（n = 49）或左心室（LV）衰竭（n = 884），我们是否应该对心源性休克的闭塞冠状动脉进行紧急血运重建？结果：右心室休克占优势的患者较年轻，既往心肌梗死的患病率较低（25.5% vs. 40.1%，p = 0.047）、前壁心肌梗死和多支血管病变（34.8 vs. 77.8%，p < 0.001），指数MI与诊断为休克之间的中位时间（2.9 vs. 6.2 h，p = 0.003）较LV休克患者短。主要RV和LV休克患者的院内死亡率分别为53.1%和60.8%（p = 0.296），两组之间血运重建对死亡率的影响无差异。多因素分析显示右心室休克不是降低住院死亡率的独立预测因素结论：尽管与LV休克患者相比，RV患者年龄较小，前壁MI发生率较低，单支冠状动脉疾病患病率较高，且两者从血运重建中获益相似，在主要为RV休克的患者中死亡率出乎意料地高，与LV休克患者相似。(C)2003年由美国心脏病学会基金会。
OBJECTIVES The purpose of this study was to determine the characteristics and outcomes of patients with acute myocardial infarction (MI) complicated by cardiogenic shock due to predominant right ventricular (RV) infarction.BACKGROUND Although RV infarction has been shown to have favorable long-term outcomes, the influence of RV infarction on mortality in cardiogenic shock is unknown.METHODS We evaluated 933 patients in cardiogenic shock due to predominant RV (n = 49) or left ventricular (LV) failure (n = 884) in the SHould we emergently revascularize Occluded coronaries for Cardiogenic shocK? (SHOCK) trial registry.RESULTS Patients with predominant RV shock were younger, with a lower prevalence of previous MI (25.5 vs. 40.1%, p = 0.047), anterior MI, and multivessel disease (34.8 vs. 77.8%, p < 0.001) and a shorter median time between the index MI and the diagnosis of shock (2.9 vs. 6.2 h, p = 0.003) in comparison to patients with LV shock. In-hospital mortality was 53.1% versus 60.8% (p = 0.296) for patients with predominant RV and LV shock, respectively, and the influence of revascularization on mortality was not different between groups. Multivariate analysis revealed that RV shock was not an independent predictor of lower in-hospital mortality (odds ratio 1.07, 95% confidence interval 0.54 to 2.13).CONCLUSIONS Despite the younger age, lower rate of anterior MI, and higher prevalence of single-vessel coronary disease of RV compared with LV shock patients, and their similar benefit from revascularization, mortality is unexpectedly high in patients with predominant RV shock and similar to patients with LV shock. (C) 2003 by the American College of Cardiology Foundation.