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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

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世界核心医学期刊文摘（心脏病学分册） 2006年第8期2卷 21-22页

作者： jeger r.v. Harkness S.M. ramanathan K. J.S. Hochman 杨海涛 Cardiovascular Clinical research Center New York University School of Medicine HCC 1173 530 First Avenue New York NY 10016 United States

Aims: To determine clinical correlates and optimal treatment strategy in patients with cardiogenic shock(CS) on admission. Methods and results: In SHould we emergently r.v.scularize 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(Prtality was higher(75 vs. 56% ; Pre rapid death(24-h mortality 40 vs. 17% ; Prgency r.v.scularization reduced in-hospital mortality in CS on admission(60 vs. 82% ; P=0.001) and in delayed CS patients similarly(46 vs.62% ; Praction 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 r.v.scularization as delayed CS patients, emphasizing the need for rapid and direct access of CS on admission patients to facilities pr.v.ding this care.

关键词：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

血运重建对≥75岁的糖尿病合并心绞痛患者长期预后的影响

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世界核心医学期刊文摘（心脏病学分册） 2005年第12期1卷 30-31页

作者： jeger r. v. Bonetti P. O. Zellweger M. J. M. E. Pfisterer 黄浙勇 Department of Cardiology University Hospital Basel Switzerland Dr.

Little is known about the effect of r.v.scularization in patients ≥75 years of age with symptomatic coronary artery disease(CAD) and diabetes mellitus(DM) for whom periprocedural risk and overall mortality are increased. Therefore, we examined the 301 patients of the Trial of Invasive versus Medical therapy in the Elderly with symptomatic CAD(TIME) with special regard to diabetic status. Patients were randomized to an invasive versus optimized medical strategy. The median follow-up was 4.1 years(range 0.1 to 6.9). Patients with DM(n=69) had a greater incidence of hypertension(73%vs 58%, p=0.03), ≥2 risk factors(93%vs 46%, pr.v.ous heart failure(22%vs 12%, p=0.04), and pr.v.ous myocardial infarction(59%vs 43%, p=0.02), and a lower left ventricular ejection fraction(48%vs 54%, p=0.02) than did patients without *** was greater in patients with DM than in those without DM(41%vs 25%, p=0.01; adjusted hazard ratio 1.86, p=0.01). r.v.scularization impr.v.d the overall survival rate from 61%(no r.v.scularization) to 79%(prd ratio 1.68, p=0.03), an effect similarly observed in patients with and without DM. The event-free survival rate was 11%in nonr.v.scularized patients with DM compared with 40%in nonr.v.scularized patients without DM and 41%and 53%in r.v.scularized patients with and without DM, respectively(pverity and antianginal drug use were similar for patients with and without DM, but those with DM performed worse in daily activities and physical functioning. In conclusion, elderly diabetic patients with chronic angina have a worse outcome than those with DM but benefit similarly from r.v.scularization regarding symptom relief and long-term outcome. However, physical functioning related to daily activities is reduced in those with DM and may need special attention.

关键词：血运重建心肌梗死史无事件生存率药物治疗射血分数总死亡率围手术期总体生存率

冠心病患者接受大型非心脏外科手术前12导联心电图的远期预后价值

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世界核心医学期刊文摘（心脏病学分册） 2006年第6期2卷 25-25页

作者： jeger r. v. Probst C. Arsenic r. M. Filipovic 赵君(译) 任付先(校) 不详 Department of Anesthesia University Hospital Basel CH 4031 Basel Switzerland

Background: Knowledge of the prognostic information of preoperative 12- lead electrocardiogram(ECG) recordings in patients with coronary artery disease(CAD) undergoing noncardiac surgery is limited. Methods: The prognostic information der.v.d from the preoperative ECGs of 172 CAD patients undergoing major noncardiac surgery was analyzed to determine its predictive value for long- term outcome. Primary end point was all- cause mortality; secondary end point was major adverse cardiac events(MACE) at 2 years. results: Pr.v.lence of ECG abnormalities was 53% for T- wave alterations; 46% for Q waves; 38% for ST deviations; and, depending on the criterion used, 2% to 19% for left ventricular hypertrophy. During follow- up, 40(23% ) patients died and 31(18% ) had MACE. After adjustment for clinical baseline findings, including current medication with β - blockers, ST depressions(odds ratio [Or] 4.5, 95% confidence interval [CI] 1.9- 10.5) and faster heart rate(Hr)(Or 1.6, 95% CI 1.1- 2.4, per 10 beats per minute [bpm] increase) were independent predictors of all- cause mortality. Faster Hr(Or 1.7, 95% CI 1.1- 2.6, per 10- bpm increase) was also an independent predictor of MACE. The predictive value of ECG variables did not change after adjustment for occurence of perioperative ischemia. Conclusion: In CAD patients, the preoperative ECG contains important prognostic information and is predictive of long- term outcome independent of clinical findings and perioperative ischemia.

关键词： 12导联心电图冠心病患者非心脏外科预后价值手术前 ECG异常不良心脏事件心率(Hr) 独立预测因素 T波电交替