st段抬高型心肌梗死所致心源性休克的主动脉内球囊反搏治疗时机是否影响生存?

Acute cardiac care Pub Date : 2014-06-01 Epub Date: 2014-03-26 DOI:10.3109/17482941.2014.881504
Niklas Bergh, Oskar Angerås, Per Albertsson, Christian Dworeck, Göran Matejka, Inger Haraldsson, Dan Ioanes, Berglind Libungan, Jacob Odenstedt, Petur Petursson, Wilhelm Ridderstråle, Truls Råmunddal, Elmir Omerovic
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引用次数: 13

摘要

背景:主动脉内球囊泵(IABP)反搏和初级经皮冠状动脉介入治疗(PCI)是心源性休克(CS)并发急性心肌梗死的标准治疗方式。本研究的目的是调查IABP治疗开始时间对PCI手术的影响。方法:从SCAAR登记处(瑞典冠状动脉造影和血管成形术登记处)获得139例连续接受IABP治疗的st段抬高型心肌梗死(STEMI)患者的数据。2004-2008年期间,患者在哥德堡萨尔格伦斯卡大学医院住院。将该队列分为两组:A组在PCI开始前开始IABP治疗(n = 72), B组在PCI治疗后开始IABP治疗(n = 67)。主要终点为30天死亡率。采用倾向评分(PS)校正Cox比例风险回归分析30天死亡率的预测因素。结果:平均年龄66.5±12岁,女性占28%。所有患者均在初次PCI前30分钟或后30分钟接受IABP治疗。63%的人患有糖尿病,28%的人患有高血压。16%是活跃烟民。30天死亡率为38%。在PCI之前或之后开始的IABP治疗不是死亡率的独立预测因子(P = 0.72)。结论:在这项非随机试验中,与初次PCI后开始的IABP相比,STEMI所致CS患者在初次PCI前插入IABP治疗与更有利的结果无关。
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Does the timing of treatment with intra-aortic balloon counterpulsation in cardiogenic shock due to ST-elevation myocardial infarction affect survival?

Background: Intra-aortic balloon pump (IABP) counterpulsation and primary percutaneous coronary intervention (PCI) are standard treatment modalities in cardiogenic shock (CS) complicating acute myocardial infarction. The aim of this study was to investigate the impact of the timing of IABP treatment start in relation to PCI procedure.

Methods: Data were obtained from the SCAAR registry (Swedish Coronary Angiography and Angioplasty Registry) about 139 consecutive patients with CS due to ST-elevation myocardial infarction (STEMI) who received IABP treatment. The patients were hospitalized at Sahlgrenska University Hospital, Gothenburg, during 2004-2008. The cohort was divided into the two groups: group (A) in whom IABP treatment started before start of PCI (n = 72) and group (B) in whom IABP treatment started after PCI treatment (n = 67). The primary endpoint was 30-day mortality. Propensity score (PS) adjusted Cox proportional hazards regression was used to analyze predictors of 30-day mortality.

Results: Mean age was 66.5 ± 12 and 28% were women. All patients have received IABP treatment 30 min before or 30 min after primary PCI. 63% had diabetes and 28% had hypertension. 16% were active tobacco smokers. The mortality rate at 30 days was 38%. IABP treatment commenced before or after PCI was not an independent predictor of mortality (P = 0.72).

Conclusion: In this non-randomized trial the treatment with insertion of IABP before primary PCI in patients with CS due to STEMI is not associated with a more favorable outcome as compared with IABP started after primary PCI.

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