Emergency revascularization in patients with cardiogenic shock on admission: a report from the SHOCK trial and registry
Emergency revascularization in patients with cardiogenic shock on admission: a report from the SHOCK trial and registry
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DOI：
10.1093/eurheartj/ehi729
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发表时间：
2006-03-01
影响因子：
39.3
通讯作者：
Hochman, JS
中科院分区：
文献类型：
--
作者：
Jeger, RV;Harkness, SM;Hochman, JS
目的：确定心源性休克（CS）患者入院时的临床相关因素和最佳治疗策略。方法和结果：在心源性休克时，我们是否应该紧急重建闭塞的冠状动脉？（SHOCK）试验和登记研究的左心室（LV）功能障碍患者（n=1053）中，26%的直接入院患者（n=166/627）在入院时发生CS。从心肌梗死到CS的时间较短，初始血流动力学特征较差，入院时CS患者的积极治疗频率低于延迟CS患者。入院时CS患者占转诊患者的相对比例（11%）（n=48/426）低于直接入院患者（P < 0.001）。与延迟性CS患者相比，CS患者入院时的院内死亡率更高（75 vs. 56%; P < 0.001），且更快死亡（24 h死亡率40 vs. 17%; P < 0.001）。急诊血运重建降低了CS患者入院时的院内死亡率（60 vs. 82%; P=0.001），延迟CS患者的院内死亡率相似（46 vs. 62%; P < 0.001;交互作用P=0.25）。经临床差异调整后，入院时CS是院内死亡率的独立预测因素（P=0.008）。结论CS入院患者的预后较差，但从急诊血运重建中获益与延迟CS患者相同，强调需要快速和直接进入CS入院患者提供这种护理的设施。
Aims To determine clinical correlates and optimal treatment strategy in patients with cardiogenic shock (CS) on admission.Methods and results In SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK? (SHOCK) trial and registry patients with left ventricular (LV) dysfunction (n=1053), CS on admission occurred in 26% of directly admitted patients (n=166/627). Time from myocardial infarction to CS was shorter, initial haemodynamic profile poorer, and aggressive treatment less frequent in CS on admission than in delayed CS patients. CS on admission patients constituted a smaller relative proportion (11%) of the transferred (n=48/426) when compared with the directly admitted cohort (P < 0.001). In-hospital mortality was higher (75 vs. 56%; P < 0.001) with more rapid death (24-h mortality 40 vs. 17%; P < 0.001) in CS on admission than in delayed CS patients. Emergency revascularization reduced in-hospital mortality in CS on admission (60 vs. 82%; P=0.001) and in delayed CS patients similarly (46 vs. 62%; P < 0.001; interaction P=0.25). After adjustment for clinical differences, CS on admission was an independent predictor of in-hospital mortality (P=0.008).Conclusion CS on admission patients have a worse outcome but benefit equally from emergency revascularization as delayed CS patients, emphasizing the need for rapid and direct access of CS on admission patients to facilities providing this care.