AIM: To assess the impact of percutaneous cardiac support in cardiogenic shock(CS) complicating acute myocardial infarction(AMI), treated with percutaneous coronary intervention. METHODS: We selected all of the studie...AIM: To assess the impact of percutaneous cardiac support in cardiogenic shock(CS) complicating acute myocardial infarction(AMI), treated with percutaneous coronary intervention. METHODS: We selected all of the studies published from January 1st, 1997 to May 15 st, 2015 that compared the following percutaneous mechanical support in patients with CS due to AMI undergoing myocardial revascularization:(1) intra-aortic balloon pump(IABP) vs Medical therapy;(2) percutaneous left ventricular assist devices(PLVADs) vs IABP;(3) complete extracorporeal life support with extracorporeal membrane oxygenation(ECMO) plus IABP vs IABP alone; and(4) ECMO plus IABP vs ECMO alone, in patients with AMI and CS undergoing myocardial revascularization. We evaluated the impact of the support devices on primary and secondary endpoints. Primary endpoint was the inhospital mortality due to any cause during the same hospital stay and secondary endpoint late mortality at 6-12 moof follow-up. RESULTS: One thousand two hundred and seventytwo studies met the initial screening criteria. After detailed review, only 30 were selected. There were 6 eligible randomized controlled trials and 24 eligible observational studies totaling 15799 patients. We found that the inhospital mortality was:(1) significantly higher with IABP support vs medical therapy(RR = +15%, P = 0.0002);(2) was higher, although not significantly, with PLVADs compared to IABP(RR = +14%, P = 0.21); and(3) significantly lower in patients treated with ECMO plus IABP vs IABP(RR =-44%, P = 0.0008) or ECMO(RR =-20%, P = 0.006) alone. In addition, Trial Sequential Analysis showed that in the comparison of IABP vs medical therapy, the sample size was adequate to demonstrate a significant increase in risk due to IABP. CONCLUSION: Inhospital mortality was significantly higher with IABP vs medical therapy. PLVADs did not reduce early mortality. ECMO plus IABP significantly reduced inhospital mortality compared to IABP.展开更多
Fulminant myocarditis is primarily caused by infection with any number of a variety of viruses. It arises quickly, progresses rapidly, and may lead to severe heart failure or circulatory failure presenting as rapid-on...Fulminant myocarditis is primarily caused by infection with any number of a variety of viruses. It arises quickly, progresses rapidly, and may lead to severe heart failure or circulatory failure presenting as rapid-onset hypotension and cardiogenic shock,with mortality rates as high as 50%–70%. Most importantly, there are no treatment options, guidelines or an expert consensus statement. Here, we provide the first expert consensus, the Chinese Society of Cardiology Expert Consensus Statement on the Diagnosis and Treatment of Fulminant Myocarditis, based on data from our recent clinical trial(NCT03268642). In this statement, we describe the clinical features and diagnostic criteria of fulminant myocarditis, and importantly, for the first time,we describe a new treatment regimen termed life support-based comprehensive treatment regimen. The core content of this treatment regimen includes(i) mechanical life support(applications of mechanical respirators and circulatory support systems,including intraaortic balloon pump and extracorporeal membrane oxygenation),(ii) immunological modulation by using sufficient doses of glucocorticoid, immunoglobulin and(iii) antiviral reagents using neuraminidase inhibitor. The proper application of this treatment regimen may and has helped to save the lives of many patients with fulminant myocarditis.展开更多
目的分析接受主动脉内球囊反搏(IABP)辅助行经皮冠状动脉介入治疗(PCI)急性冠状动脉综合征(ACS)合并心源性休克患者的特征及预后情况。方法回顾性分析北京安贞医院2014年1月至2015年12月应用IABP辅助行PCI的ACS合并心源性休克患者197例...目的分析接受主动脉内球囊反搏(IABP)辅助行经皮冠状动脉介入治疗(PCI)急性冠状动脉综合征(ACS)合并心源性休克患者的特征及预后情况。方法回顾性分析北京安贞医院2014年1月至2015年12月应用IABP辅助行PCI的ACS合并心源性休克患者197例,根据患者生存情况分为存活组(162例)和死亡组(35例),比较两组患者的临床特点及住院不良事件的发生情况。结果 197例患者平均年龄(57.3±14.7)岁,入院时平均动脉压(53.3±14.6)mmHg(1 mmHg=0.133 kPa)。两组患者入院时性别、吸烟、高血压病、高脂血症、肌酸激酶同工酶(CK-MB)、血肌酸酐比较,差异均无统计学意义(均P>0.05);而存活组患者年龄、2型糖尿病、陈旧性心肌梗死、心肌肌钙蛋白I(cTnI)水平显著低于死亡组(均P<0.05)。IABP置入前后,存活组患者收缩压、舒张压、平均动脉压、心脏指数的升高水平显著大于死亡组,差异均有统计学意义(均P<0.05);而两组患者心率、动脉血氧饱和度的升高值比较,差异均无统计学意义(均P>0.05)。两组患者罪犯血管在左前降支、左回旋支、右冠状动脉,完全血管化,TIMI血流Ⅲ级,症状发作-球囊扩张时间,进门-球囊扩张时间比较,差异均无统计学意义(均P>0.05);存活组患者罪犯血管在左主干比例、术后24 h CK-MB值、术后24 h cTnI值显著小于死亡组,差异均有统计学意义(均P<0.05);而ST段回落>50%比例显著大于死亡组患者,差异亦有统计学意义(P<0.05)。存活组患者再发心肌梗死、急性肾损伤、床旁血滤、有创机械通气发生率及住院时间显著低于死亡组患者,差异均有统计学意义(均P<0.05);而两组患者血管活性药使用率比较,差异无统计学意义(P>0.05)。结论 ACS合并心源性休克患者进行IABP辅助PCI存在较高的不良事件发生风险。死亡组患者表现为高龄、合并2型糖尿病及陈旧性心肌梗死,且存在较高的再发心肌梗死、急性肾损伤�展开更多
文摘AIM: To assess the impact of percutaneous cardiac support in cardiogenic shock(CS) complicating acute myocardial infarction(AMI), treated with percutaneous coronary intervention. METHODS: We selected all of the studies published from January 1st, 1997 to May 15 st, 2015 that compared the following percutaneous mechanical support in patients with CS due to AMI undergoing myocardial revascularization:(1) intra-aortic balloon pump(IABP) vs Medical therapy;(2) percutaneous left ventricular assist devices(PLVADs) vs IABP;(3) complete extracorporeal life support with extracorporeal membrane oxygenation(ECMO) plus IABP vs IABP alone; and(4) ECMO plus IABP vs ECMO alone, in patients with AMI and CS undergoing myocardial revascularization. We evaluated the impact of the support devices on primary and secondary endpoints. Primary endpoint was the inhospital mortality due to any cause during the same hospital stay and secondary endpoint late mortality at 6-12 moof follow-up. RESULTS: One thousand two hundred and seventytwo studies met the initial screening criteria. After detailed review, only 30 were selected. There were 6 eligible randomized controlled trials and 24 eligible observational studies totaling 15799 patients. We found that the inhospital mortality was:(1) significantly higher with IABP support vs medical therapy(RR = +15%, P = 0.0002);(2) was higher, although not significantly, with PLVADs compared to IABP(RR = +14%, P = 0.21); and(3) significantly lower in patients treated with ECMO plus IABP vs IABP(RR =-44%, P = 0.0008) or ECMO(RR =-20%, P = 0.006) alone. In addition, Trial Sequential Analysis showed that in the comparison of IABP vs medical therapy, the sample size was adequate to demonstrate a significant increase in risk due to IABP. CONCLUSION: Inhospital mortality was significantly higher with IABP vs medical therapy. PLVADs did not reduce early mortality. ECMO plus IABP significantly reduced inhospital mortality compared to IABP.
基金funded by the National Key Basic Research Project (2012CB518004)Natural Science Fund Key Project (81630010)
文摘Fulminant myocarditis is primarily caused by infection with any number of a variety of viruses. It arises quickly, progresses rapidly, and may lead to severe heart failure or circulatory failure presenting as rapid-onset hypotension and cardiogenic shock,with mortality rates as high as 50%–70%. Most importantly, there are no treatment options, guidelines or an expert consensus statement. Here, we provide the first expert consensus, the Chinese Society of Cardiology Expert Consensus Statement on the Diagnosis and Treatment of Fulminant Myocarditis, based on data from our recent clinical trial(NCT03268642). In this statement, we describe the clinical features and diagnostic criteria of fulminant myocarditis, and importantly, for the first time,we describe a new treatment regimen termed life support-based comprehensive treatment regimen. The core content of this treatment regimen includes(i) mechanical life support(applications of mechanical respirators and circulatory support systems,including intraaortic balloon pump and extracorporeal membrane oxygenation),(ii) immunological modulation by using sufficient doses of glucocorticoid, immunoglobulin and(iii) antiviral reagents using neuraminidase inhibitor. The proper application of this treatment regimen may and has helped to save the lives of many patients with fulminant myocarditis.
文摘目的分析接受主动脉内球囊反搏(IABP)辅助行经皮冠状动脉介入治疗(PCI)急性冠状动脉综合征(ACS)合并心源性休克患者的特征及预后情况。方法回顾性分析北京安贞医院2014年1月至2015年12月应用IABP辅助行PCI的ACS合并心源性休克患者197例,根据患者生存情况分为存活组(162例)和死亡组(35例),比较两组患者的临床特点及住院不良事件的发生情况。结果 197例患者平均年龄(57.3±14.7)岁,入院时平均动脉压(53.3±14.6)mmHg(1 mmHg=0.133 kPa)。两组患者入院时性别、吸烟、高血压病、高脂血症、肌酸激酶同工酶(CK-MB)、血肌酸酐比较,差异均无统计学意义(均P>0.05);而存活组患者年龄、2型糖尿病、陈旧性心肌梗死、心肌肌钙蛋白I(cTnI)水平显著低于死亡组(均P<0.05)。IABP置入前后,存活组患者收缩压、舒张压、平均动脉压、心脏指数的升高水平显著大于死亡组,差异均有统计学意义(均P<0.05);而两组患者心率、动脉血氧饱和度的升高值比较,差异均无统计学意义(均P>0.05)。两组患者罪犯血管在左前降支、左回旋支、右冠状动脉,完全血管化,TIMI血流Ⅲ级,症状发作-球囊扩张时间,进门-球囊扩张时间比较,差异均无统计学意义(均P>0.05);存活组患者罪犯血管在左主干比例、术后24 h CK-MB值、术后24 h cTnI值显著小于死亡组,差异均有统计学意义(均P<0.05);而ST段回落>50%比例显著大于死亡组患者,差异亦有统计学意义(P<0.05)。存活组患者再发心肌梗死、急性肾损伤、床旁血滤、有创机械通气发生率及住院时间显著低于死亡组患者,差异均有统计学意义(均P<0.05);而两组患者血管活性药使用率比较,差异无统计学意义(P>0.05)。结论 ACS合并心源性休克患者进行IABP辅助PCI存在较高的不良事件发生风险。死亡组患者表现为高龄、合并2型糖尿病及陈旧性心肌梗死,且存在较高的再发心肌梗死、急性肾损伤�
