Improved outcome of cardiogenic shock at the acute stage of myocardial infarction: a report from the USIK 1995, USIC 2000, and FAST-MI French Nationwide Registries
Improved outcome of cardiogenic shock at the acute stage of myocardial infarction: a report from the USIK 1995, USIC 2000, and FAST-MI French Nationwide Registries
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DOI：
10.1093/eurheartj/ehs264
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发表时间：
2012-10-01
影响因子：
39.3
通讯作者：
Danchin, Nicolas
中科院分区：
文献类型：
--
作者：
Aissaoui, Nadia;Puymirat, Etienne;Danchin, Nicolas
急性心肌梗死（AMI）患者心源性休克（CS）发生率和结局的历史演变存在争议。这项研究比较了1995年至2005年AMI患者的结果，根据CS的存在。三个全国性的法国登记处进行了5年的时间间隔，使用类似的方法在连续患者入院超过1个月的时间。所有7531名症状发作48小时的AMI患者均被纳入其中。比较了486例CS患者与非CS患者的死亡率演变。CS的发生率随时间呈下降趋势（1995年为6.9; 2005年为5.7，P 0.07）。CS患者的30天死亡率显著较高（60.9 vs. 5.2）。在10年期间，CS患者（7051，P 0.003）和非CS患者（94，P 0.001）的死亡率均降低。在CS患者中，经皮冠状动脉介入治疗（PCI）的使用从20例增加到50例（P 0.001）。时间周期是CS患者早期死亡率的独立预测因子（死亡OR，2005 vs. 1995 0.45; 95 CI：0.27 0.75，P 0.005），沿着年龄、糖尿病和吸烟状态。当加入多变量模型时，PCI与死亡率降低相关（OR 0.38; 95 CI：0.240.58，P 0.001）。在倾向评分匹配的队列中，冠状动脉综合征患者行PCI的生存率显著提高。心源性休克仍然是临床关注的问题，尽管早期死亡率有所下降。生存率的提高伴随着PCI的更广泛使用和急性期的推荐药物。然而，在急性期之后，1年生存率保持不变。
The historical evolution of incidence and outcome of cardiogenic shock (CS) in acute myocardial infarction (AMI) patients is debated. This study compared outcomes in AMI patients from 1995 to 2005, according to the presence of CS.Three nationwide French registries were conducted 5 years apart, using a similar methodology in consecutive patients admitted over a 1-month period. All 7531 AMI patients presenting 48 h of symptom onset were included. The evolution of mortality was compared in the 486 patients with CS vs. those without CS. The incidence of CS tended to decrease over time (6.9 in 1995; 5.7 in 2005, P 0.07). Thirty-day mortality was considerably higher in CS patients (60.9 vs. 5.2). Over the 10-year period, mortality decreased for both patients with (7051, P 0.003) and without CS (94, P 0.001). In CS patients, the use of percutaneous coronary intervention (PCI) increased from 20 to 50 (P 0.001). Time period was an independent predictor of early mortality in CS patients (OR for death, 2005 vs. 1995 0.45; 95 CI: 0.270.75, P 0.005), along with age, diabetes, and smoking status. When added to the multivariate model, PCI was associated with decreased mortality (OR 0.38; 95 CI: 0.240.58, P 0.001). In propensity-score-matched cohorts, CS patients with PCI had a significantly higher survival.Cardiogenic shock remains a clinical concern, although early mortality has decreased. Improved survival is concomitant with a broader use of PCI and recommended medications at the acute stage. Beyond the acute stage, however, 1-year survival has remained unchanged.