<br>心肌梗死对心源性休克治疗和结果的影响,Journal of the American Heart Association

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心肌梗死对心源性休克治疗和结果的影响
Journal of the American Heart Association ( IF 5.0 ) Pub Date : 2021-10-29 , DOI: 10.1161/jaha.121.021570
Richard G Jung _{1,

2,

3} , Pietro Di Santo _{1,

4,

5} , Rebecca Mathew _{1,

5,

6} , Omar Abdel-Razek _{1,

5} , Simon Parlow _{1,

5} , Trevor Simard _{1,

3,

5,

7} , Jeffrey A Marbach _{1,

8} , Taylor Gillmore ₂ , Brennan Mao ₂ , Jordan Bernick ₉ , Pascal Theriault-Lauzier _{1,

5} , Angel Fu _{1,

5} , Lawrence Lau _{1,

5} , Pouya Motazedian ₁₀ , Juan J Russo _{1,

5} , Marino Labinaz _{1,

5} , Benjamin Hibbert _{1,

3,

4,

5}

Affiliation

背景随机DOREMI（多巴酚丁胺与米力农比较）临床试验评估了米力农和多巴酚丁胺对心源性休克患者的疗效和安全性。按急性心肌梗死分层时结果是否保持一致仍不清楚。在这项亚研究中，我们试图评估心源性休克并发急性心肌梗死 (AMICS) 与非 AMICS 的临床治疗和结局方面的差异。方法和结果心源性休克患者 (n=192) 按 1:1 随机分配至多巴酚丁胺或米力农。该亚组分析的主要复合终点是全因住院死亡率、心脏骤停、非致命性心肌梗塞、脑血管意外、机械循环支持的需要或 30 天开始肾脏替代治疗 (RRT) 。对接受 AMICS 的患者 (n=65) 和不接受 AMICS 的患者 (n=127) 的患者进行结果评估。 AMICS 的主要复合终点显着高于非 AMICS（风险比 [HR]，2.21；95% CI，1.47–3.30； P = 0.0001）。主要终点是由全因死亡率、机械循环支持和 RRT 的增加所驱动。没有观察到其他次要结局（包括心脏骤停或脑血管意外）的差异。在调整年龄、性别、程序性对比剂使用、多支血管疾病和正性肌力药物类型后，AMICS 仍然与主要综合结局、30 天死亡率和 RRT 相关。结论 AMI 与心源性休克不良临床结局发生率增加相关，并且与死亡率以及开始机械循环支持和 RRT 的情况。血运重建期间给予造影剂可能会导致 RRT 率增加。 AMICS 与非 AMICS 的结果异质性凸显了研究心源性休克特定亚组干预措施的必要性。唯一标识符：NCT03207165。

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Implications of Myocardial Infarction on Management and Outcome in Cardiogenic Shock

BackgroundThe randomized DOREMI (Dobutamine Compared to Milrinone) clinical trial evaluated the efficacy and safety of milrinone and dobutamine in patients with cardiogenic shock. Whether the results remain consistent when stratified by acute myocardial infarction remains unknown. In this substudy, we sought to evaluate differences in clinical management and outcomes of acute myocardial infarction complicated by cardiogenic shock (AMICS) versus non‐AMICS.Methods and ResultsPatients in cardiogenic shock (n=192) were randomized 1:1 to dobutamine or milrinone. The primary composite end point in this subgroup analysis was all‐cause in‐hospital mortality, cardiac arrest, non‐fatal myocardial infarction, cerebrovascular accident, the need for mechanical circulatory support, or initiation of renal replacement therapy (RRT) at 30‐days. Outcomes were evaluated in patients with (n=65) and without (n=127) AMICS. The primary composite end point was significantly higher in AMICS versus non‐AMICS (hazard ratio [HR], 2.21; 95% CI, 1.47–3.30; P=0.0001). The primary end point was driven by increased rates of all‐cause mortality, mechanical circulatory support, and RRT. No differences in other secondary outcomes including cardiac arrest or cerebrovascular accident were observed. AMICS remained associated with the primary composite outcome, 30‐day mortality, and RRT after adjustment for age, sex, procedural contrast use, multivessel disease, and inotrope type.ConclusionsAMI was associated with increased rates of adverse clinical outcomes in cardiogenic shock along with increased rates of mortality and initiation of mechanical circulatory support and RRT. Contrast administration during revascularization likely contributes to increased rates of RRT. Heterogeneity of outcomes in AMICS versus non‐AMICS highlights the need to study interventions in specific subgroups of cardiogenic shock.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT03207165.

更新日期：2021-11-02

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