老年人急性心肌梗死合并心源性休克临床特点分析

The clinical characteristics and angiographic findings of cardiogenic shock following acute myocardial infarction in elderly patients

目的探讨老年人发生急性心肌梗死合并心源性休克的临床特点。方法入选2015年1月至2016年4月就诊于天津市胸科医院的急性心肌梗死合并心源性休克（CS）的老年患者。所有人选患者接受急诊冠状动脉造影检查，并根据病变特点完成急诊经皮冠状动脉血管成形术（PCI）治疗，按照是否发生心源性休克分为心源性休克组及非心源性休克组，调查两组患者的一般资料、心肌梗死的特点、冠状动脉介入检查及治疗结果。结果在发生急性心肌梗死的老年患者中，8．33％（34／408）发生CS，在所有CS患者中，91．89％（34／37）为老年患者，住院期间死亡率29．41％（10／34）。发生CS患者的白细胞计数、高敏C反应蛋白、人院血糖、肌酐、谷丙转苷酶水平均高于未发生CS患者（t=2．403，4．596，6．778，6．109，均P〈0．05）。发生CS患者有更高的人院NT—ProBNP水平，更长的首次医疗接触时间，更多的左主干病变以及3支病变。结果老年患者有更高比例发生CS的风险，过长的首次医疗接触时间、存在左主干病变以及3支病变是发生CS的独立预测因素，而积极的血运重建可以明显增加老年患者的生存机会。

Objective To investigate the clinical characteristics and angiographic findings of cardiogenic shock（ CS） following acute myocardial infarction（AMI）in elderly patients. Methods Between January 2015 and April 2016, we carried out a retrospective observational analysis of consecutive elderly patients in Tianjin Chest Hospital, who suffered CS-complicating AMI. Emergency angiography and percutaneous coronary intervention（PCI） were performed after admission. All selected patients were divided into CS and non-CS groups according to whether CS occurred. Electrocardiograph （ECG）, cardiac enzyme testing, and ultrasound cardiography were performed after admission to monitor the occurrence of CS. Results The incidence of CS-complicating AMI was 8.33% （34/408） in elderly patients. Among all CS patients enrolled, the aged patients accounted for 91.89 %（34/37 ）. In-hospital mortality rate was 29.41%（10/34）. There were significant differences between two groups in WBC, Hs-CRP, blood glucose, CR and ALT（t= 2. 403,4. 596,6. 778,6. 109, each P〈0.05）. The NT-Pro BNP level, the time of FMC, the frequency of left main and multivessel disease were higher in the CS group than in the non-CS group（each P〈0.05）. Conclusions Elderly patients are bearing high risk of CS following AMI. Prolonged FMC time and the presence of left main and/or multivessel lesion are independent risk factors for the development of CS. The optimal revascularisation strategy can improve the clinical outcome of patients with CS.