机械循环支持下急性心肌梗死合并心源性休克患者死亡的危险因素分析  

Analysis of the mortality risk factors of mechanical circulatory support in patients with acute myocardial infarction and cardiogenic shock

作　　者：张宁[1] 刘文娴[1] 康云鹏[1] Zhang Ning;Liu Wenxian;Kang Yunpeng(Deparment of Cardiology Beijing Institute of Heart,Lung and Blood Vssel Disease,Beijing Anzhen Hospial,Capial Medical University,Beijing100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心内科监护室,北京100029

出　　处：《中华胸心血管外科杂志》2024年第7期399-405,共7页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：北京市卫生健康委员会卫生健康科技成果和适宜技术推广项目(BHTPP2022091)。

摘　　要：目的回顾性分析机械循环支持(MCS)导致急性心肌梗死合并心源性休克(AMICS)患者死亡的危险因素。方法纳入2018年1月至2024年1月在北京安贞医院住院的234例AMICS患者。其中死亡组(79例), 生存组(155例)。117例患者在经皮冠状动脉介入治疗(PCI)后接受了MCS治疗(定义为延迟MCS治疗)。比较死亡组及生存组患者的基线资料及临床资料, 分析可能影响死亡的潜在危险因素。结果统计学分析结果表明, 较高的白细胞数量(OR=1.017, P=0.003, 95%CI:1.005~1.028), 较高的动脉乳酸水平(OR=2.021, P<0.001, 95%CI:1.463~2.794), 冠状动脉三支病变(OR=3.179, P<0.001, 95%CI:1.679~6.019), 延迟MCS治疗(OR=4.691, P=0.001, 95%CI:1.955~11.258), MCS辅助单独使用主动脉内球囊反搏(IABP)(OR=4.140, P<0.001, 95%CI:2.230~7.786), 是MCS辅助下AMICS患者死亡的独立危险因素。动脉乳酸水平显示出对于MCS辅助下AMICS患者的死亡有一定预测价值, 其受试者工作特征曲线下面积0.719, P<0.001, 95%CI:0.667~0.770, 最大约登指数0.395, 临界值5.05 mmol/L。结论高白细胞数、高动脉乳酸水平(>5.05 mmol/L)、冠状动脉三支病变、延迟MCS治疗、MCS辅助单独使用主动脉内球囊反搏是MCS辅助下AMICS患者死亡的独立危险因素。Objective:This was a retrospective study to analyze the risk factors for death in patients with acute myocardial infarction complicated with cardiogenic shock(AMICS)under mechanical circulatory support(MCS).Methods:This study included 234 patients with AMICS who were admitted to Anzhen Hospital in Beijing from January 2018 to January 2024.Among them,79 cases died and 155 cases survived.117 patients received MCS after percutaneous coronary intervention(PCI)(defined as delayed MCS treatment).Baseline and clinical data of patients in the death group and the survival group were compared to analyze the potential risk factors that may affect death.Results:Statistical analysis showed that higher white blood cell count(OR=1.017,P=0.003,95%CI:1.005-1.028),higher arterial lactate level(OR=2.021,P<0.001,95%CI:1.463-2.794),three-vessel coronary artery disease(OR=3.179,P<0.001,95%CI:1.679-6.019),delayed MCS treatment(OR=4.691,P=0.001,95%CI:1.955-11.258),MCS assisted aortic balloon counterpulsation alone(IABP)(OR=4.140,P<0.001,95%CI:2.230-7.786)were independent risk factors for in-hospital mortality in AMICS patients under mechanical circulatory support.The arterial lactate level were shown to be predictive of death in patients with AMICS assisted by MCS,and an area under the receiving operating characteristic curve of 0.719,P<0.001,95%CI:0.667-0.770,the maximum Youden index was 0.395,and the cutoff value of 5.05 mmol/L.Conclusion:Higher number of white blood cells,high arterial lactate level(>5.05 mmol/L),three-vessel coronary artery disease,delayed MCS treatment,and McS-assisted aortic balloon counterpulsation alone were independent risk factors for mortality in patients with McS-assisted AMICS.

关 键 词：急性心肌梗死 心源性休克 机械循环支持 危险因素 

分 类 号：R542.22[医药卫生—心血管疾病] R541.64[医药卫生—内科学]