美国心血管造影和介入学会休克分类在真实世界急性心肌梗死合并心原性休克的应用价值

Application of Society of Cardiovascular Imaging and Intervention shock classification in the patients with acute myocardial infarction complicated with cardiogenic shock in the real world

目的评价修订版美国心血管造影和介入学会(SCAI)休克分类对真实世界中急性心肌梗死合并心原性休克(AMICS)的应用价值。方法回顾性收集2019年1月1日至2021年12月31日中国医学科学院阜外医院深圳医院收治的确诊为急性心肌梗死(AMI)的患者病历资料,根据传统休克和2019年及修订版的SCAI休克分类标准分析符合AMICS诊断的患者,并进行分期,分析患者临床特征、干预措施及预后。结果960例AMI患者中,符合传统休克诊断的有38例(3.96%),出院30 d内死亡21例(55.26%)。2019版和修订版SCAI休克分类的AMICS均有104例(10.83%),从A到E期分期一致,分别有32.69%、25.96%、19.23%、10.58%和11.54%。相应各期的出院30 d内死亡例数分别为1例(2.94%)、0例、3例(15.00%)、8例(72.73%)、12例(100.00%)。血运重建组86例(82.69%),总死亡率17.44%,A至E期死亡率分别为0、0、16.67%、71.43%、100.00%。非血运重建患者17例,死亡8例,死亡率47.06%。冠状动脉病变方面,A/B期单支病变占比更高;E/D期三支病变占比较高。随着SCAI休克分期的递增,使用血管活性药、机械通气、主动脉内球囊反搏(IABP)使用均增加(均P<0.001)。B期患者使用血管活性药占比77.78%,出院30 d死亡率均为0。C期IABP组死亡率0,非IABP组死亡率42.86%,而D期和E期使用IABP与否未见差异。C/D期使用体外膜肺氧合较E期的好。结论修订版的SCAI休克分类更能早期识别AMICS患者,并有较强的预后预测能力;不同的SCAI休克分期可以有不同的干预措施。

Objective To evaluate the clinical value of the Society of Cardiovascular Imaging and Intervention(SCAI)updated shock classification for patients with acute myocardial infarction(AMI)complicated with cardiogenic shock(AMICS).Methods We retrospectively enrolled patients with documented AMI who admitted to Shenzhen Fuwai Hospital between January 1st 2019 and December 31st 2021.We used three criteria,namely conventional,the 2019 and the updated SCAI criteria,to determine the AMICS diagnosis of patients and the disease stage.We also evaluate the clinical characteristics,interventions and outcomes of these patients.Results A total of 960 AMI patients were identified,and among these patients,38(3.96%)were qualified for the conventional criteria,and 21 patients(55.26%)died before the 30-day after discharge.Based on the 2019 and the updated SCAI criteria,104(10.83%)were diagnosed as AMICS,and the proportions of patients from stage A to E were consistent using these two criteria,from 32.69%,to 25.96%,19.23%,10.58%,and 11.54%.The corresponding mortality rate was:2.94%,0,15.00%,72.73%and 100.00%.86(82.69%)patients underwent revascularization,and the total mortality rate was 17.44%,and from stage A to E was:0,0,16.67%,71.43%and 100.00%.The mortality rate in patients without revascularization was 47.06%.With respect to the coronary disease,patients with stage A and B were more likely to have single vessel disease;while patients with stage D and E were more likely to have three vessels disease.The use of vasoactive drugs,ventilation,and IABP increase with increasing AMICS stage(all P<0.001).77.78%of patients with stage B were treated with vasoactive drugs,and thirty-day mortality rate was 0.Among stage C patients,mortality rate in those with IABP treatment was 0 while in those without IABP treatment was 42.86%.In patients with stage D and E,there was no difference in mortality rate between those with versus without IABP treatment.Among patients who were treated with ECMO,those with stage C and D had better survival than those with stage E.Conclusions The updated SCAI criteria had better value for early identify patients with AMICS and also had better predictive value for survival.Different stage might require different treatment strategies.