Impact of thrombolysis, intra-aortic balloon pump counterpulsation, and their combination in cardiogenic shock complicating acute myocardial infarction: A report from the SHOCK Trial Registry
Impact of thrombolysis, intra-aortic balloon pump counterpulsation, and their combination in cardiogenic shock complicating acute myocardial infarction: A report from the SHOCK Trial Registry
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DOI：
10.1016/s0735-1097(00)00875-5
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发表时间：
2000-09-01
影响因子：
24
通讯作者：
Hochman, JS
中科院分区：
文献类型：
--
作者：
Sanborn, TA;Sleeper, LA;Hochman, JS
我们试图研究溶栓治疗（TT）和主动脉内球囊反搏（IABP）对入选前瞻性研究的患者住院死亡率的潜在益处，回顾性研究表明，急性心肌梗死（MI）并发心源性休克（CS）的患者，在TT基础上增加IABP支持时的住院死亡率。这一假设迄今尚未进行前瞻性研究，致力于CS。方法1,190例患者参加了36个参与中心，884例CS由于主要左心室（LV）衰竭。排除26例在休克发作前放置IABP的患者和2例数据不完整的患者，评价了856例患者的TT和IABP使用情况。由当地医生选择的治疗分为四类：无TT、无IABP（33%; n = 285）;仅IABP（33%; n = 279）;仅TT（15%; n = 132）; TT和IABP（19%;结果：CS患者经TT治疗后，其住院病死率明显低于未接受TT治疗者（54% vs. 64%，p = 0.005），选择IABP的患者的院内死亡率低于未接受IABP的患者（50% vs. 72%，p < 0.0001）。此外，四个治疗组之间的住院死亡率存在显著差异：TT + IABP（47%）、仅IABP（52%）、仅TT（63%）、无TT、无IABP（77%）（p < 0.0001）。接受早期IABP的患者（溶栓治疗后≤ 6 h，n = 72）的院内死亡率与接受晚期IABP的患者相似（分别为53% vs. 41%，n = 64，p = 0.172）。四组的血运重建率不同：无TT、无IABP（18%）;仅IABP（70%）;仅TT（20%）; TT和IABP（68%，p < 0.0001）;这显著影响了住院死亡率（39%进行了血运重建，78%未进行血运重建，结论：在本登记研究中，与标准药物治疗相比，TT、IABP和经皮冠状动脉成形术/冠状动脉旁路移植术血运重建治疗主要由左心室衰竭引起的心源性休克患者的住院死亡率较低。对于没有血运重建能力的医院，早期TT和IABP，然后立即转移到PTCA或CABG的策略可能是合适的。然而，选择偏差是明显的，需要进一步的调查。（美国科尔心脏病学杂志2000;36：1123-9）（C）2000年美国心脏病学会。
OBJECTIVES We sought to investigate the potential benefit of thrombolytic therapy (TT) and intra-aortic balloon pump counterpulsation (IABP) on in-hospital mortality rates of patients enrolled in a prospective, multi-center Registry of acute myocardial infarction (MI) complicated by cardiogenic shock (CS).BACKGROUND Retrospective studies suggest that patients suffering from CS due to MI have lower in-hospital mortality rates when IABP support is added to TT. This hypothesis has not heretofore been examined prospectively in a study devoted to CS.METHODS Of 1,190 patients enrolled at 36 participating centers, 884 patients had CS due to predominant left ventricular (LV) failure. Excluding 26 patients with IABP placed prior to shock onset and 2 patients with incomplete data, 856 patients were evaluated regarding TT and IABP utilization. Treatments, selected by local physicians, fell into four categories: no TT, no IABP (33%; n = 285); IABP only (33%; n = 279); TT only (15%; n = 132); and TT and IABP (19%; n = 160).RESULTS Patients in CS treated with TT had a lower in-hospital mortality than those who did not receive TT (54% vs. 64%, p = 0.005), and those selected for IABP had a lower in-hospital mortality than those who did not receive IABP (50% vs. 72%, p < 0.0001). Furthermore, there was a significant difference in in-hospital mortality among the four treatment groups: TT + IABP (47%), IABP only (52%), TT only (63%), no TT, no IABP (77%) (p < 0.0001). Patients receiving early IABP (less than or equal to 6 h after thrombolytic therapy, n = 72) had in-hospital mortality similar to those with late IABP (53% vs. 41%, n = 64, respectively, p = 0.172). Revascularization rates differed among the four groups: no TT, no IABP (18%); IABP only (70%); TT only (20%); TT and IABP (68%, p < 0.0001); this influenced in-hospital mortality significantly (39% with revascularization vs. 78% without revascularization, p < 0.0001).CONCLUSIONS Treatment of patients in cardiogenic shock due to predominant LV failure with TT, IABP and revascularization by PTCA/CABG was associated with lower in-hospital mortality rates than standard medical therapy in this Registry. For hospitals without revascularization capability, a strategy of early TT and IABP followed by immediate transfer for PTCA or CABG may be appropriate. However, selection bias is evident and further investigation is required. (J Am Coll Cardiol 2000;36:1123-9) (C) 2000 by the American College of Cardiology.