编者按:心源性休克大部分由心肌梗死引起,数据显示,6%~8%的ST段抬高型心肌梗死(STEMI)患者可发生心源性休克,是导致死亡的最主要原因。在本届美国心脏协会(AHA)科学年会上,中国医学科学院阜外医院杨跃进教授研究团队发表了题为“Cardiogenic Shock Complicating ST-Elevated Myocardial Infarction in China: Data From the China Acute Myocardial Infarction Registry”的精彩研究。现将会上展示的精彩内容,与读者共享。
编者按:心源性休克大部分由心肌梗死引起,数据显示,6%~8%的ST段抬高型心肌梗死(STEMI)患者可发生心源性休克,是导致死亡的最主要原因。在本届美国心脏协会(AHA)科学年会上,中国医学科学院阜外医院杨跃进教授研究团队发表了题为“Cardiogenic Shock Complicating ST-Elevated Myocardial Infarction in China: Data From the China Acute Myocardial Infarction Registry”的精彩研究。现将会上展示的精彩内容,与读者共享。
陈桂浩博士在AHA现场进行壁报展示
在再灌注时代,急性心肌梗死(Acute Myocardial Infarction,AMI)并发心源性休克(Cardiogenic shock,CS)(AMICS)的院内死亡率仍较高(27%~51%)。尽管目前已有许多研究(NIS,GRACE, CUB-Réa,NCDR,CathPCI,NHDS,AMIS,NRMI)报道过AMICS,但数据都来自外国,得出的结论不能很好地反映AMICS在中国的现状。在本届AHA科学年会上,中国医学科学院阜外医院杨跃进研究团队展示的最新研究(Cardiogenic Shock Complicating ST-Elevated Myocardial Infarction in China: Data From the China Acute Myocardial Infarction Registry)旨在探讨中国ST段抬高AMI(STEMI)并发CS(STEMICS)的发病率、治疗和院内预后。
该项研究纳入2013年1月至2016年1月因STEMI在中国急性心肌梗死(CAMI)注册研究中登记的28 230例患者。结果显示,我国STEMICS的发病率为8.1%(2273),且STEMICS的发病率与医院级别的高低有明显相关性。县级医院中STEMICS的发病率明显高于市、省(13.76%、8.46%和5.23%,P<0.001)级别医院。另外,本研究中STEMICS患者行直接经皮腔内冠状动脉介入治疗(Primary percutaneous coronary intervention,PPCI )的比例仅为29.7%,远低于欧美国家的比例(~50%)。而且,县级医院中STEMICS患者行PPCI的比例明显低于市、省级别医院(8.0%,31.5%和46.5%,P< 0.001)。
研究还发现,我国STEMICS的住院死亡率(In-hospital mortality,IHM)达49.8%;县级医院院前STEMICS的IHM明显高于市、省级别医院(42.3%、33.3% 和28.3%,P=0.0077),而院内STEMICS和总STEMICS的IHM在不同级别医院中无明显差异。
进一步分析显示,在校正PPCI后,县级医院的院前STEMICS患者的IHM与省级医院(OR=0.63,95%Cl:0.34~1.17)和市级医院(OR=0.64,95%Cl:0.38~1.08)无显著统计学差异。该研究结果提示,我国(特别是县级医院)STEMICS的现状不容乐观,需要采取更多强有力的措施(如增加PPCI的比例)以降低STEMICS的发生率和住院死亡率。
AHA 2017 杨跃进教授研究团队精彩壁报英文原文:
T2198 - Cardiogenic Shock Complicating ST-Elevated Myocardial Infarction in China: Data From the China Acute Myocardial Infarction Registry
Introduction: Cardiogenic shock (CS) remains the leading cause of death in patients with ST-Elevated Myocardial Infarction(STEMI) and no data have investigated the situation of CS complicating STEMI in China. Objective: The objective of this study is to describe the incidence, management and in-hospital mortality (IHM) of CS complicating STEMI in China and at different levels of hospitals (county-level, prefectural and provincial hospitals) .
Methods: The study population consisted of 28230 patients registered consecutively in the China Acute Myocardial Infarction (CAMI) registry from January 2013 to January 2016 who were hospitalized with an STEMI.
Results: During the years under study, 2273 patients (8.1%) developed STEMICS. The proportion of STEMI patients developing CS in provincial, prefectural and county-level hospitals were 5.23%, 8.46% and 13.76% (P < 0.001), respectively. Primary PCI was performed on 675 patients (29.7%) with STEMICS. The proportion of STEMICS patients undertaking primary PCI in provincial, prefectural and county-level hospitals were 46.5%, 31.5% and 8.0% (P < 0.001). The overall IHM of patients with STEMICS was 49.8%. No difference was observed in the IHM of STEMICS among the different hospital levels. However, the IHM of prehospital STEMICS(STEMICS occurred before hospitalization)in county-level hospitals were significantly higher than that in prefectural and provincial hospitals (42.3% versus 33.3% and 28.3%, respectively; P<0.01), while the IHM of in-hospital STEMICS (STEMICS developed during hospitalization)were similar among the different hospital levels (66.5%, 66.9% and 62.2%; provincial, prefectural and county-level hospitals, respectively). After adjustment, the difference of IHM in prehospital STEMICS between county-level hospitals and the other two levels no longer existed. However, once PPCI is excluded from the multivariable adjustment model, the IHM of prehospital STEMICS remained higher in county-level hospitals.
Conclusion: continuous efforts are needed to reduce the incidence and IHM of CS complicating STEMI in China, especially those who are treated in county-level hospitals.