入院时即发生心源性休克的患者中的急诊血运重建:来自SHOCK试验和登记的报道

作     者：Jeger R.V. Harkness S.M. Ramanathan K. J.S. Hochman 杨海涛 

作者机构：Cardiovascular Clinical Research Center New York University School of Medicine HCC 1173 530 First Avenue New York NY 10016 United States 

出 版 物：《世界核心医学期刊文摘（心脏病学分册）》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2006年第2卷第8期

页      面：21-22页

学科分类：1002[医学-临床医学] 1011[医学-护理学（可授医学、理学学位）] 10[医学] 

主　　题：心源性休克 休克患者 血运重建 入院时 急诊 试验 院内死亡率 临床相关因素 左室功能不全 闭塞冠状动脉 

摘      要：Aims: To determine clinical correlates and optimal treatment strategy in patients with cardiogenic shock(CS) on admission. Methods and results: In SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK?(SHOCK) trial and registry patients with left ventricular(LV) dysfunction(n=1053), CS on admission occurred in 26% of directly admitted patients(n=166/627). Time from myocardial infarction to CS was shorter, initial haemodynamic profile poorer, and aggressive treatment less frequent in CS on admission than in delayed CS patients. CS on admission patients constituted a smaller relative proportion(11% ) of the transferred(n=48/426) when compared with the directly admitted cohort(P 0.001). Inhospital mortality was higher(75 vs. 56% ; P 0.001) with more rapid death(24-h mortality 40 vs. 17% ; P 0.001) in CS on admission than in delayed CS patients. Emergency revascularization reduced in-hospital mortality in CS on admission(60 vs. 82% ; P=0.001) and in delayed CS patients similarly(46 vs.62% ; P 0.001; interaction P=0.25). After adjustment for clinical differences, CS on admission was an independent predictor of in-hospital mortality(P=0.008). Conclusion: CS on admission patients have a worse outcome but benefit equally from emergency revascularization as delayed CS patients, emphasizing the need for rapid and direct access of CS on admission patients to facilities providing this care.