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
Objectives： To investigate the effect of Shenfu Injection（参附注射液, SFI） on inflammatory factors in patients with acute myocardial infarction complicated by cardiogenic shock（CS） treated with and intra-aortic b...Objectives： To investigate the effect of Shenfu Injection（参附注射液, SFI） on inflammatory factors in patients with acute myocardial infarction complicated by cardiogenic shock（CS） treated with and intra-aortic balloon pump（IABP）. Methods： This study enrolled 60 patients with ST-segment elevation myocardial infarction（STEMI） complicated by CS. Patients underwent IABP and emergency percutaneous coronary intervention（PCI） were randomly divided into two groups by random number table with 30 cases in each group, one given SFI treatment（100 m L/24 h）, one not. The two groups were then compared in a clinical setting for left ventricular function, biochemical indicators and Inflammatory factors, including C-reactive proteins（CRP）, interleukin-1（IL-1） and tumor necrosis factor alpha（TNF-α）. Major adverse cardiac and cerebrovascular events（MACCE） events were compared between patients of the two groups both in-hospital and in follow-ups. Results： The IABP support treatment times of patients in the IABP＋SFI group were significantly shorter than the IABP group（52.87±28.84 vs. 87.45±87.31, P=0.047）. In the patients of the IABP＋SFI group, the CRP peak appeared in 24 h after PCI operation. The CRP peak in the patients of the IABP＋SFI group was significantly lower than that in the IABP group（31.27±3.93 vs. 34.62±3.47, P=0.001）. The increases in range of TNF-α in the patients of the IABP＋SFI group were significantly lower than those of the IABP group（182.29±22.79 vs. 195.54±12.02, P=0.007）. The increases in range of IL-1 in the patients of the IABP＋SFI group were significantly lower than those of the IABP group（214.98±29.22 vs. 228.60±7.03, P=0.019）. The amplitude elevated TNF-α 72 h after admission was an independent risk factor of in-hospital MACCE events（OR 0.973, 95% CI 0.890–0.987, P=0.014） in patients with STEMI and CS. Conclusion： Patients with STEMI complicated by CS treated by IABP and SFI had a reduced inflammatory reaction, 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Supported by Beijing Chinese Medicine Technology Development Surfaces Subject of Special Funds(No.JJ2013-19)
文摘Objectives： To investigate the effect of Shenfu Injection（参附注射液, SFI） on inflammatory factors in patients with acute myocardial infarction complicated by cardiogenic shock（CS） treated with and intra-aortic balloon pump（IABP）. Methods： This study enrolled 60 patients with ST-segment elevation myocardial infarction（STEMI） complicated by CS. Patients underwent IABP and emergency percutaneous coronary intervention（PCI） were randomly divided into two groups by random number table with 30 cases in each group, one given SFI treatment（100 m L/24 h）, one not. The two groups were then compared in a clinical setting for left ventricular function, biochemical indicators and Inflammatory factors, including C-reactive proteins（CRP）, interleukin-1（IL-1） and tumor necrosis factor alpha（TNF-α）. Major adverse cardiac and cerebrovascular events（MACCE） events were compared between patients of the two groups both in-hospital and in follow-ups. Results： The IABP support treatment times of patients in the IABP＋SFI group were significantly shorter than the IABP group（52.87±28.84 vs. 87.45±87.31, P=0.047）. In the patients of the IABP＋SFI group, the CRP peak appeared in 24 h after PCI operation. The CRP peak in the patients of the IABP＋SFI group was significantly lower than that in the IABP group（31.27±3.93 vs. 34.62±3.47, P=0.001）. The increases in range of TNF-α in the patients of the IABP＋SFI group were significantly lower than those of the IABP group（182.29±22.79 vs. 195.54±12.02, P=0.007）. The increases in range of IL-1 in the patients of the IABP＋SFI group were significantly lower than those of the IABP group（214.98±29.22 vs. 228.60±7.03, P=0.019）. The amplitude elevated TNF-α 72 h after admission was an independent risk factor of in-hospital MACCE events（OR 0.973, 95% CI 0.890–0.987, P=0.014） in patients with STEMI and CS. Conclusion： Patients with STEMI complicated by CS treated by IABP and SFI had a reduced inflammatory reaction,
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�
