收稿日期: 2024-04-07
网络出版日期: 2024-12-16
基金资助
国家自然科学基金项目(82274316)
Effect of different methods of hemodynamic support for patients with cardiac shock complicating acute myocardial infarctionduring percutaneous coronary intervention process
Received date: 2024-04-07
Online published: 2024-12-16
目的 比较急性心肌梗死合并心源性休克患者在不同器械辅助支持下进行急诊经皮介入治疗术的临床效果。 方法 回顾性分析2015年1月至2019年12月期间在医院接受急诊经皮介入治疗术的急性心肌梗死合并心源性休克患者。根据患者接受的血流动力学支持方式，分为体外膜肺氧合联合主动脉球囊反搏（ECMO联合IABP）支持的研究组，以及单纯IABP支持的对照组。比较两组患者的临床预后差别。 结果 共有40例患者纳入研究，其中研究组11例，对照组29例。两组患者在基线资料如年龄、性别、合并症等方面无显著差异。相较于对照组，研究组的陈旧性心肌梗死发生率（5/11 vs. 2/29， P = 0.016）和非ST段抬高型心肌梗死的发生率（8/11 vs. 11/29， P = 0.49）更高；研究组入院时左室射血分数更低［（38.5 ± 10.10） vs. （48.55 ± 8.86）， P = 0.01］，EF值< 35%的患者比例更多（5/11 vs. 3/29，P = 0.01）；研究组的多支血管疾病率和Syntax评分也明显高于对照组（10/11 vs. 11/29，P = 0.02）和［（33.36 ± 13.37） vs. （25.74 ± 5.75），P = 0.015］ ；研究组完全血运重建的比例更高（9/11 vs. 8/29，P = 0.002）；研究组器械辅助支持并发症的发生率较高（6/11 vs. 5/29， P = 0.02）。研究组的1年生存率明显高于对照组（91.00% vs. 55.17%， P = 0.03）。 结论 急性心肌梗死合并心源性休克患者接受急诊经皮冠状动脉介入治疗术时，ECMO联合IABP的器械辅助支持方式并发症相对较高，但更有利于完全血运重建，临床预后更好。
罗明华 , 陈玉善 , 王贺 , 关怀敏 , 解金红 . 急性心肌梗死合并心源性休克患者不同器械辅助支持下急诊经皮介入治疗效果[J]. 实用医学杂志, 2024 , 40(23) : 3317 -3322 . DOI: 10.3969/j.issn.1006-5725.2024.23.006
Objective To evaluate the effect of extracorporeal membrane oxygenation combined with intra-aortic balloon pump mechanical circulatory support for patients with cardiogenic shock complicating acute myocardial infarction during PCI process. Methods Patients with cardiogenic shock complicating myocardial infarction who underwent PCI in the hospital from January 2015 to December 2019 were selected. Those who were under support of extracorporeal membrane oxygenation combined with intra-aortic balloon pump were enrolled in the observation group， the patients under support of only intra-aortic balloon pump were selectedin the control group. The differences of clinical features and prognosis were compared. Results A total of 40 patients were enrolled， 11 were in the observation group and 29 in the control group. Compared with control group， more patients were complicated with old myocardial infarction （5/11 vs. 2/29， P = 0.016）， more patients were diagnosed as non-ST elevated myocardial infarction （8/11 vs. 11/29， P = 0.049） and left ventricular ejecting fraction was lower ［（38.5 ± 10.10） vs. （48.55 ± 8.86）， P = 0.01］ in observation group. Moreover， the proportion of patients with EF < 35% was higher in the observation group （5/11 vs. 3/29， P = 0.01）. The observation group has significantly higher rates of multi-vessel disease and Syntax scores compared to the control group （multi-vessel disease： 10/11 vs. 11/29， P = 0.02； Syntax score： ［（33.36 ± 13.37） vs. （25.74 ± 5.75）， P = 0.015］； the observation group exhibited a higher proportion of patients achieving complete revascularization（9/11 vs. 8/29，P = 0.002）. Mechanical complications were higher in observation group（6/11 vs. 5/29， P = 0.02）， The survive rate in observation group is higher than that in control group（91.00% vs.55.17%， P = 0.03）at one-year follow-up. Conclusion Compared with only IABP， ECMO combined with IABP hemodynamic support during PCI process for patients with cardiogenic shock complicating acute myocardial infarction enjoys more complete revascularization and better mortality outcome， although it has relatively higher mechanical complications.
| 1 | SAMSKY M D， MORROW D A， PROUDFOOT A G， et al. Cardiogenic shock after acute myocardial infarction： A review［J］. JAMA， 2021，326（18）：1840-1850. doi:10.1001/jama.2021.18323 |
| 2 | 刘淼淼， 郭锋伟， 刘锋锋， 等. 静脉-动脉体外膜氧合辅助心源性休克的危险因素分析：一项连续5年的回顾性分析［J］. 实用医学杂志， 2022， 38（6）： 743-748. |
| 3 | BARAN D A， GRINES C L， BAILEY S， et al. SCAI clinical expert consensus statement on the classification of cardiogenic shock： This document was endorsed by the American College of Cardiology （ACC）， the American Heart Association （AHA）， the Society of Critical Care Medicine （SCCM）， and the Society of Thoracic Surgeons （STS） in April 2019［J］. Catheter Cardiovasc Interv， 2019， 94（1）： 29-37. doi:10.1002/ccd.28329 |
| 4 | HOCHMAN J S， SLEEPER L A， WEBB J G， et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock［J］. N Engl J Med， 1999，341（9）：625-634. |
| 5 | SLEEPER L A， RAMANATHAN K， PICARD M H， et al. Functional status and quality of life after emergency revascularization for cardiogenic shock complicating acute myocardial infarction［J］. J Am Coll Cardiol， 2005， 46（2）： 266-273. doi:10.1016/j.jacc.2005.01.061 |
| 6 | ZEYMER U， THIELE H. Mechanical Support for Cardiogenic Shock： Lost in Translation［J］. J Am Coll Cardiol， 2017， 69（3）：288-290. doi:10.1016/j.jacc.2016.10.025 |
| 7 | NISHIMOTO Y， INOHARA T， KOHSAKA S， et al. Changing Trends in Mechanical Circulatory Support Use and Outcomes in Patients Undergoing Percutaneous Coronary Interventions for Acute Coronary Syndrome Complicated With Cardiogenic Shock： Insights From a Nationwide Registry in Japan［J］. J Am Heart Assoc， 2023， 12（23）： e031838. doi:10.1161/jaha.123.031838 |
| 8 | YEO I， AXMAN R， LU D Y， et al. Impella Versus Intra-Aortic Balloon Pump in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation： An Observational Study［J］. J Am Heart Assoc， 2024， 13（3）： e032607. doi:10.1161/jaha.123.032607 |
| 9 | THIELE H， OHMAN E M， DESCH S， et al. Management of cardiogenic shock［J］. Eur Heart J， 2015， 36（20）：1223-1230. doi:10.1093/eurheartj/ehv051 |
| 10 | BAHEKAR A， SINGH M， SINGH S， et al. Cardiovascular outcomes using intra-aortic balloon pump in high-risk acute myocardial infarction with or without cardiogenic shock： A meta-analysis［J］. J Cardiovasc Pharmacol Ther， 2012， 17（1）： 44-56. doi:10.1177/1074248410395019 |
| 11 | LUO D， HUANG R， WANG X， et al. Intra-Aortic Balloon Pump Reduces 30-Day Mortality in Early-Stage Cardiogenic Shock Complicating Acute Myocardial Infarction According to SCAI Classification［J］. Shock， 2023， 60（3）： 385-391. |
| 12 | THIELE H， ZEYMER U， NEUMANN F J， et al. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock （IABP-SHOCK Ⅱ）： Final 12 month results of a randomised， open-label trial［J］. Lancet， 2013， 382（9905）： 1638-1645. doi:10.1016/s0140-6736(13)61783-3 |
| 13 | IBANEZ B， JAMES S， AGEWALL S， et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation： The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology （ESC） ［J］. Eur Heart J， 2018， 39（2）： 119-177. |
| 14 | SHEU J J， TSAI T H， LEE F Y， et al. Early extracorporeal membrane oxygenator-assisted primary percutaneous coronary intervention improved 30-day clinical outcomes in patients with ST-segment elevation myocardial infarction complicated with profound cardiogenic shock［J］. Crit Care Med， 2010， 38（9）：1810-1817. doi:10.1097/ccm.0b013e3181e8acf7 |
| 15 | BRUNNER S， GUENTHER S， LACKERMAIR K， et al. Extracorporeal Life Support in Cardiogenic Shock Complicating Acute Myocardial Infarction［J］. J Am Coll Cardiol， 2019， 73（18）：2355-2357. doi:10.1016/j.jacc.2019.02.044 |
| 16 | 赵倩， 张艳， 乔荞， 邓爱云. 体外膜肺氧合支持下经皮冠状动脉介入治疗患者预后的影响因素［J］. 实用医学杂志， 2024， 40（2）： 219-224. doi:10.13201/j.issn.1001-1439.2024.02.007 |
| 17 | RUSSO J J， ALEKSOVA N， PITCHER I， et al. Left ventricular unloading during extracorporeal membrane oxygenation in patients with cardiogenic shock［J］. J Am Coll Cardiol， 2019， 73（6）：654-662. doi:10.1016/j.jacc.2018.10.085 |
| 18 | AL-ATTA A， ZAIDAN M， ABDALWAHAB A， et al. Mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock［J］. Rev Cardiovasc Med， 2022， 23（2）：71. doi:10.31083/j.rcm2302071 |
| 19 | COMBES A， PRICE S， SLUTSKY A S， et al. Temporary circulatory support for cardiogenic shock［J］. Lancet， 2020， 396（10245）： 199-212. doi:10.1016/s0140-6736(20)31047-3 |
| 20 | CHENG R， HACHAMOVITCH R， MAKKAR R， et al. Lack of survival benefit found with use of intraaortic balloon pump in extracorporeal membrane oxygenation： A pooled experience of 1517 patients［J］. J Invasive Cardiol， 2015， 27（10）： 453-458. |
| 21 | BRéCHOT N， DEMONDION P， SANTI F， et al. Intra-aortic balloon pump protects against hydrostatic pulmonary oedema during peripheral venoarterial-extracorporeal membrane oxygenation［J］. Eur Heart J Acute Cardiovasc Care， 2018， 7（1）： 62-69. doi:10.1177/2048872617711169 |
| 22 | VALLABHAJOSYULA S， O'HORO J C， ANTHARAM P， et al. Concomitant intra-aortic balloon pump use in cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation［J］. Circ Cardiovasc Interv， 2018， 11（9）：e006930. doi:10.1161/circinterventions.118.006930 |
| 23 | VAN DEN BRINK F S， ZIVELONGHI C， VOSSENBERG T N， et al. VA-ECMO with IABP is associated with better outcome than VA-ECMO alone in the treatment of cardiogenic shock in ST-Elevation myocardial infarction［J］. J Invasive Cardiol， 2021，33（5）：E387-E392. doi:10.25270/jic/20.00085 |
| 24 | COCO V LO， LORUSSO R， RAFFA G M， et al. Clinical complications during veno-arterial extracorporeal membrane oxigenation in post-cardiotomy and non post-cardiotomy shock： Still the achille's heel［J］. J Thorac Dis， 2018，10（12）：6993-7004. doi:10.21037/jtd.2018.11.103 |
| 25 | NEUMANN F J， SOUSA-UVA M， AHLSSON A， et al. 2018 ESC/EACTS Guidelines on myocardial revascularization［J］. Eur Heart J， 2019，40（2）：87-165. doi:10.1093/eurheartj/ehy855 |
| 26 | KAPUR N K， KANWAR M， SINHA S S， et al. Criteria for defining stages of cardiogenic shock severity［J］. J Am Coll Cardiol， 2022，80（3）：185-198. doi:10.1016/j.jacc.2022.04.049 |
/
| 〈 |
|
〉 |