Cardiogenic shock complicating acute myocardial infarction - Etiologies, management and outcome: A report from the SHOCK Trial Registry
Cardiogenic shock complicating acute myocardial infarction - Etiologies, management and outcome: A report from the SHOCK Trial Registry
复制标题
DOI：
10.1016/s0735-1097(00)00879-2
复制
发表时间：
2000-09-01
影响因子：
24
通讯作者：
LeJemtel, T
中科院分区：
文献类型：
--
作者：
Hochman, JS;Buller, CE;LeJemtel, T
目的：本休克研究报告旨在提供心源性休克（CS）并发急性心肌梗死（MI）患者的概述以及各种治疗的结果。在休克试验注册表和休克试验中接受血运重建术的患者的结果进行比较。背景：心源性休克是急性心肌梗死住院患者死亡的主要原因。随机休克试验报告早期血运重建可提高6个月生存率。方法：未纳入同期随机试验的CS合并急性心肌梗死患者进行登记。记录患者的特征以及出院时的程序和生命体征。结果：1993年4月至1997年8月，在SHOCK试验中登记了1190例CS患者，其中232例被随机分组。主要的左心室衰竭（78.5%）最为常见，孤立性右室休克占2.8%，严重二尖瓣反流占6.9%，室间隔破裂占3.9%，心包填塞占1.4%。住院登记死亡率为60%，室间隔破裂的死亡率（87.3%）明显高于其他所有类别（p < 0.01）。接受溶栓治疗和/或主动脉内球囊反搏、冠状动脉造影术、血管成形术和/或冠状动脉搭桥手术的登记患者的风险概况和死亡率较低。在对这些差异进行调整后，早期血运重建改善生存率的程度与随机休克试验中观察到的相似。结论：在这项前瞻性登记中，12%的CS病因为机械并发症。在SHOCK试验注册表和SHOCK试验中，早期血运重建术患者的有益治疗效果的相似性为SHOCK试验结果的普遍性提供了强有力的支持。[J] journal of Cardiology; 2000;36:1063-70。
OBJECTIVES This SHOCK Study report seeks to provide an overview of patients with cardiogenic shock (CS) complicating acute myocardial infarction (MI) and the outcome with various treatments. The outcome of patients undergoing revascularization in the SHOCK Trial Registry and SHOCK Trial are compared.BACKGROUND Cardiogenic shock is the leading cause of death in patients hospitalized for acute MI. The randomized SHOCK Trial reported improved six-month survival with early revascularization.METHODS Patients with CS complicating acute MI who were not enrolled in the concurrent randomized trial were registered. Patient characteristics were recorded as were procedures and vital status at hospital discharge.RESULTS Between April 1993 and August 1997, 1,190 patients with CS were registered and 232 were randomized in the SHOCK Trial. Predominant left ventricular failure (78.5%) was most common, with isolated right ventricular shock in 2.8%, severe mitral regurgitation in 6.9%, ventricular septal rupture in 3.9% and tamponade in 1.4%. In-hospital Registry mortality was 60%, with ventricular septal rupture associated with a significantly higher mortality (87.3%) than all other categories (p < 0.01). The risk profile and mortality were lower for Registry patients who were managed with thrombolycic therapy and/or intra-aortic balloon counterpulsation, coronary angiography, angioplasty and/or coronary artery bypass surgery. After adjusting for these differences, the extent to which survival was improved with early revascularization was similar to that observed in the randomized SHOCK Trial.CONCLUSIONS In this prospective Registry the etiology of CS was a mechanical complication in 12%. The similarity of the beneficial treatment effect in patients undergoing early revascularization in the SHOCK Trial Registry and SHOCK Trial provides strong support for the generalizability of the SHOCK Trial results. (J Am Coil Cardiol 2000;36:1063-70) (C) 2000 by the American College of Cardiology.