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

doi:10.3969/j.issn.1006-5725.2024.23.006

Abstract

Abstract:

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.

Key words: acute myocardial infarction, cardiogenic shock, extracorporeal membrane oxygenation, intra-aortic balloon pump, primary percutaneous coronary intervention, mechanical circulatory support

CLC Number:

R541.4

Minghua LUO,Yushan CHEN,He WANG,Huaimin GUAN,Jinhong. XIE. Effect of different methods of hemodynamic support for patients with cardiac shock complicating acute myocardial infarctionduring percutaneous coronary intervention process[J]. The Journal of Practical Medicine, 2024, 40(23): 3317-3322.

Figures/Tables 3

Tab.1

Fig.1

Tab.2

References 26

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变量	研究组（n = 11）	对照组（n = 29）	t/χ²/Z值	P值
临床资料
年龄（x ± s）/岁	63.60 ± 14.47	66.38 ± 14.47	0.54	0.60
女性	1（9.10）	10（34.48）	3.16	0.08
BMI（x ± s）/（kg/m²）	24.75 ± 3.90	24.77 ± 2.22	0.02	0.99
高血压	7（63.64）	21（72.41）	0.02	0.88
糖尿病	4（36.36）	6（20.69）	0.38	0.54
高脂血症	1（9.09）	2（6.90）	0.00	1.00
吸烟	6（54.55）	11（37.93）	2.13	0.15
陈旧性心梗	5（45.45）	2（6.90）	5.76	0.016
COPD	1（9.09）	2（6.90）	0.00	1.00
中风或TIA	3（27.27）	9（31.03）	0.00	1.00
临床表现
STEMI	3（27.27）	18（62.07）	3.87	0.049
NSTEMI	8（72.72）	11（37.93）	3.87	0.049
电复律	2（18.18）	8（27.59）	0.04	0.838
入院时心率（x ± s））/ bpm	85.10 ± 21.00	83.97 ± 19.22	0.16	0.88
入院时收缩压（x ± s）/ mmHg	85.20 ± 9.22	89.52 ± 17.89	0.52	0.61
CK峰值［M（P₂₅， P₇₅）］/（ng/mL）	374（188，520）	2 196.6（371.5，4 552.0）	2.30	0.002
CK-MB峰值［M（P₂₅， P₇₅）］/（ng/mL）	40（29.5，55）	210（34.5，320）	2.49	0.013
eGFR（x ± s）/（mL/min/1.73m ）	82.19 ± 18.36	77.40 ± 29.59	177	0.596
EF（x ± s）/ %	38.5 ± 10.10	48.55 ± 8.86	2.68	0.01
EF < 35%	5（45.45）	3（10.34）	6.14	0.01
冠状动脉病变及处理
LAD	10（90.91）	24（82.76）	0.42	0.52
Lcx	7（63.64）	8（27.59）	4.42	0.04
RCA	7（63.64）	8（27.59）	4.42	0.04
LM	4（36.36）	4（13.79）	2.54	0.11
Syntax评分（x ± s）/分	33.36 ± 13.37	25.74 ± 5.75	2.55	0.015
多支病变	10（90.91）	11（37.93）	8.98	0.002
完全血运重建	9（81.82）	8（27.59）	9.60	0.002
器械辅助支持数据
ECMO应用时程（x ± s）/h	32.09 ± 28.72	-	-	-
IABP应用时程（x ± s）/h	72.70 ± 58.49	31.62 ± 29.76	2.24	0.045
成功脱机	10（90.91）	21（72.41）	1.56	0.21
器械支持并发症	6（54.55）	5（17.24）	5.57	0.02
住院天数（x ± s）/d	24.36 ± 9.46	14.17 ± 12.32	2.11	0.04

生存率	研究组（n = 11）	对照组（n = 29）	P值
出院时	10（90.91）	19（65.51）	0.11
1个月	10（90.91）	17（58.62）	0.05
2个月	10（90.91）	17（58.62）	0.05
6个月	10（90.91）	17（58.62）	0.05
12个月	10（90.91）	16（55.17）	0.03

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Effect of different methods of hemodynamic support for patients with cardiac shock complicating acute myocardial infarctionduring percutaneous coronary intervention process

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