BACKGROUND Cardiogenic shock(CS)is a life-threatening complication of acute myocardial infarction with high morbidity and mortality rates.Primary percutaneous coro-nary intervention(PCI)has been shown to improve outco...BACKGROUND Cardiogenic shock(CS)is a life-threatening complication of acute myocardial infarction with high morbidity and mortality rates.Primary percutaneous coro-nary intervention(PCI)has been shown to improve outcomes in patients with CS.AIM To investigate the immediate mortality rates in patients with CS undergoing primary PCI and identify mortality predictors.METHODS We conducted a retrospective analysis of 305 patients with CS who underwent primary PCI at the National Institute of Cardiovascular Diseases,Karachi,Pak-istan,between January 2018 and December 2022.The primary outcome was immediate mortality,defined as mortality within index hospitalization.Uni-variate and multivariate logistic regression analyses were performed to identify predictors of immediate mortality.RESULTS In a sample of 305 patients with 72.8%male patients and a mean age of 58.1±11.8 years,the immediate mortality rate was found to be 54.8%(167).Multivariable analysis identified Killip class IV at presentation[odds ratio(OR):2.0;95%co-nfidence interval(CI):1.2-3.4;P=0.008],Multivessel disease(OR:3.5;95%CI:1.8-6.9;P<0.001),and high thrombus burden(OR:2.6;95%CI:1.4-4.9;P=0.003)as independent predictors of immediate mortality.CONCLUSION Immediate mortality rate in patients with CS undergoing primary PCI remains high despite advances in treatment strategies.Killip class IV at presentation,multivessel disease,and high thrombus burden(grade≥4)were identified as independent predictors of immediate mortality.These findings underscore the need for aggressive management and close monitoring of patients with CS undergoing primary PCI,particularly in those with these high-risk characteristics.展开更多
Objective To review the presentation,diagnosis and recent developments in the pharmacological and invasive treatment of ST elevation myocardial infarction (STEMI) with a special focus on health-care organization in or...Objective To review the presentation,diagnosis and recent developments in the pharmacological and invasive treatment of ST elevation myocardial infarction (STEMI) with a special focus on health-care organization in order to increase accessibility of primary pemutaneous coronary intervention (PCI).Data sources Data were obtained from English publications on STEMI treatment.No formal systematic review was conducted,but an effort was made to be comprehensive.Study selection Studies were selected if they contained data relevant to the topic.Preferably,data from clinical randomized trials,meta-analyses,guidelines and a few recent reviews are referenced.Results The described clinical approach to acute myocardial infarction (AMI) has been a continuum of scientific results and translation into clinical practice over the last four decades since the advent of thrombolytic reperfusion.This has resulted in a dramatic in-hospital mortality decrease from 30% in the 1960s to the present 5%.The biggest survival benefits have undoubtedly been achieved after the advent of reperfusion strategies.In contemporary treatment of STEMI,additional treatment effects on survival have to be sought in the very early admission phase,as the current mortality hazard drops significantly after the first critical days to continuously very low levels after discharge.Conclusions Optimal treatment of STEMI patients is best performed with a widely accessible reperfusion strategy,preferably primary PCI,with contemporary peri-procedural anti-thrombotic treatment and device implantation.Accessibility of reperfusion strategies is increased by efficient STEMI networks applying prehospital triage with digital tele-transmission of electrocardiograms (ECGs) and seamless patient transitions between health-care unities.Efficient treatments of complicated STEMI with out-of hospital cardiac arrest and/or cardiogenic shock underline the necessity of structured referral systems,preferably immediately after the initial STEMI diagnosis。展开更多
1文献来源
Zeymer U, Hochadel M, Hauptmann KE, et al. Intra-aortic balloon pump in patients with acute myocardial infarction complicated by cardiogenic shock： Results of the ALKK-PCI registry[J]. Clin Res Cardiol, 2...1文献来源
Zeymer U, Hochadel M, Hauptmann KE, et al. Intra-aortic balloon pump in patients with acute myocardial infarction complicated by cardiogenic shock： Results of the ALKK-PCI registry[J]. Clin Res Cardiol, 2013,102（3） ：223-227.展开更多
目的:探讨急性心肌梗死并心源性休克患者的抢救方法及影响因素。方法:收集本院急性心肌梗死并心源性休克的患者83例,根据治疗方式不同分为急诊介入干预组(n=42)和强化药物治疗组(n=41),其中急诊介入干预组再按进入导管室不同流程分为绿...目的:探讨急性心肌梗死并心源性休克患者的抢救方法及影响因素。方法:收集本院急性心肌梗死并心源性休克的患者83例,根据治疗方式不同分为急诊介入干预组(n=42)和强化药物治疗组(n=41),其中急诊介入干预组再按进入导管室不同流程分为绿色通道组(n=33)和常规入院流程组(n=9),比较组间死亡率和住院费用及急诊介入干预组组内的球囊扩张(door to balloon)时间差异。结果:急诊介入干预组死亡13例(30.95%),住院费用(9.83±6.18)万元;强化药物治疗组死亡24例(58.24%),住院费用(1.73±1.77)万元,差异有统计学意义(P<0.05)。急诊介入干预组内患者就诊到球囊扩张时间,绿色通道流程组为(66.82±19.75)min,常规入院流程组为(131.33±36.44)min,差异有统计学意义(P<0.05)。结论:绿色通道能提高急诊经皮冠状动脉介入术(PCI)的抢救成功率并能显著改善患者的治疗效果,急性心肌梗死并心源性休克患者应尽快进行急诊经皮冠状动脉介入术(PCI),以赢得宝贵时间,挽救患者生命。展开更多
文摘BACKGROUND Cardiogenic shock(CS)is a life-threatening complication of acute myocardial infarction with high morbidity and mortality rates.Primary percutaneous coro-nary intervention(PCI)has been shown to improve outcomes in patients with CS.AIM To investigate the immediate mortality rates in patients with CS undergoing primary PCI and identify mortality predictors.METHODS We conducted a retrospective analysis of 305 patients with CS who underwent primary PCI at the National Institute of Cardiovascular Diseases,Karachi,Pak-istan,between January 2018 and December 2022.The primary outcome was immediate mortality,defined as mortality within index hospitalization.Uni-variate and multivariate logistic regression analyses were performed to identify predictors of immediate mortality.RESULTS In a sample of 305 patients with 72.8%male patients and a mean age of 58.1±11.8 years,the immediate mortality rate was found to be 54.8%(167).Multivariable analysis identified Killip class IV at presentation[odds ratio(OR):2.0;95%co-nfidence interval(CI):1.2-3.4;P=0.008],Multivessel disease(OR:3.5;95%CI:1.8-6.9;P<0.001),and high thrombus burden(OR:2.6;95%CI:1.4-4.9;P=0.003)as independent predictors of immediate mortality.CONCLUSION Immediate mortality rate in patients with CS undergoing primary PCI remains high despite advances in treatment strategies.Killip class IV at presentation,multivessel disease,and high thrombus burden(grade≥4)were identified as independent predictors of immediate mortality.These findings underscore the need for aggressive management and close monitoring of patients with CS undergoing primary PCI,particularly in those with these high-risk characteristics.
文摘Objective To review the presentation,diagnosis and recent developments in the pharmacological and invasive treatment of ST elevation myocardial infarction (STEMI) with a special focus on health-care organization in order to increase accessibility of primary pemutaneous coronary intervention (PCI).Data sources Data were obtained from English publications on STEMI treatment.No formal systematic review was conducted,but an effort was made to be comprehensive.Study selection Studies were selected if they contained data relevant to the topic.Preferably,data from clinical randomized trials,meta-analyses,guidelines and a few recent reviews are referenced.Results The described clinical approach to acute myocardial infarction (AMI) has been a continuum of scientific results and translation into clinical practice over the last four decades since the advent of thrombolytic reperfusion.This has resulted in a dramatic in-hospital mortality decrease from 30% in the 1960s to the present 5%.The biggest survival benefits have undoubtedly been achieved after the advent of reperfusion strategies.In contemporary treatment of STEMI,additional treatment effects on survival have to be sought in the very early admission phase,as the current mortality hazard drops significantly after the first critical days to continuously very low levels after discharge.Conclusions Optimal treatment of STEMI patients is best performed with a widely accessible reperfusion strategy,preferably primary PCI,with contemporary peri-procedural anti-thrombotic treatment and device implantation.Accessibility of reperfusion strategies is increased by efficient STEMI networks applying prehospital triage with digital tele-transmission of electrocardiograms (ECGs) and seamless patient transitions between health-care unities.Efficient treatments of complicated STEMI with out-of hospital cardiac arrest and/or cardiogenic shock underline the necessity of structured referral systems,preferably immediately after the initial STEMI diagnosis。
文摘1文献来源
Zeymer U, Hochadel M, Hauptmann KE, et al. Intra-aortic balloon pump in patients with acute myocardial infarction complicated by cardiogenic shock： Results of the ALKK-PCI registry[J]. Clin Res Cardiol, 2013,102（3） ：223-227.
文摘目的:探讨急性心肌梗死并心源性休克患者的抢救方法及影响因素。方法:收集本院急性心肌梗死并心源性休克的患者83例,根据治疗方式不同分为急诊介入干预组(n=42)和强化药物治疗组(n=41),其中急诊介入干预组再按进入导管室不同流程分为绿色通道组(n=33)和常规入院流程组(n=9),比较组间死亡率和住院费用及急诊介入干预组组内的球囊扩张(door to balloon)时间差异。结果:急诊介入干预组死亡13例(30.95%),住院费用(9.83±6.18)万元;强化药物治疗组死亡24例(58.24%),住院费用(1.73±1.77)万元,差异有统计学意义(P<0.05)。急诊介入干预组内患者就诊到球囊扩张时间,绿色通道流程组为(66.82±19.75)min,常规入院流程组为(131.33±36.44)min,差异有统计学意义(P<0.05)。结论:绿色通道能提高急诊经皮冠状动脉介入术(PCI)的抢救成功率并能显著改善患者的治疗效果,急性心肌梗死并心源性休克患者应尽快进行急诊经皮冠状动脉介入术(PCI),以赢得宝贵时间,挽救患者生命。
