The Short-term Prognosis Analysis And Evaluation Of The Prognostic Score Of Acute Myocardial Infarction Combined With Cardiogenic Shock

[Objective]To establish a database of cardiogenic shock complicated by acute myocardial infarction in our hospital,and to analyze the clinical features and short-term prognosis of these patients,in order to investigate the risk factors of short-term mortality.[Methods]We collected data of one hundred and ninty-eight patients with a diagnosis of cardiogenic shock complicated by acute myocardial infarction,patients were grouped by 28-day-mortality,known as survival group and non-survival group.With comparison of clinical features and physiological parameters between the 2 groups,risk factors of short-term mortality were analyzed by means of logistic analysis.[Results]198 patients admitted in our hospital between June 1st 2010 to Jan 31st 2018,with a diagnosis of cardiogenic shock complicated by acute myocardial infarction,were enrolled in this study,and 28-day mortality was as high as 64.65%.Compared those in survival group,non-survivors showed a lower rate of male gender and STEMI,lower body weight,higher incidence of hypertension and history of PCI,and presented with a lower SBP and DBP,higher respiratory rate,lower count of hemoglobin and platelet,higher levels of sodium,potassium,creatinine and ALT,higher chances of being invasively ventilated,lower levels of arterial pH,HC03-,and higher level of lactate,with statistically significance.According to multiple logistic analysis,arterial pH(OR=0.021,95%CI:0.01-0.614,p =0.025),creatinine(OR=1.016,95%CI:1.006-1.025,p =0.002)and SBP(OR=0.914,95%CI:0.849-0.984,p =0,017)proved to be independent risk factors of 28-day-mortality of these patients.Among them,126 patients received emergent coronary angiography,28-day-mortality was 61.1%prevalence of 3-vessel disease was similar between survivors and non-survivors(48.98%vs.44.16%,p =0.60),mortality between patients with and without LM as culprit leision was also similar(58.8%vs.61.5%,X2=0.017,p=0.895);Non-survivors showed a remarkable higher incidence of post-procedural TIMI flow less than grade 2(76.63%vs.6.12%,p<0.01),compared with survivors.In logistic analysis,post-procedural TIMI flow(OR=0.389,95%CI:0.156-0.868,p =0.022)、serum creatinine(OR=1.010,95%CI:1.000-1.019,p =0.044)、lactate(OR=1.146,95%CI:0.978-1.343,p =0.032)proved to be independent predictors of short-term mortality of cardiogenic shock patients who received coronary angiography.[Conclusion]Cardiogenic shock complicated by acute myocardial infarction still had a high mortality,SBP,arterial pH and serum creatinine could be independent risk factors of short-term mortality in these patients.Among those who received coronary angiography and PCI,final TIMI flow,creatinine and lactate could predict their short-term prognosis.[Objective]To investigate and compare the predictive power of different scoring systems in evaluation of short term mortality in patients with cardiogenic shock complicated by acute myocardial infarction.[Methods]The study enrolled 198 patients admitted in our hospital between June 1st 2010 to Jan 31st 2018,with a diagnosis of cardiogenic shock complicated by acute myocardial infarction.We calculated the scores of APACHE Ⅱ,APACHE Ⅲ,SAPS Ⅱ,PAMI,TIMI-STEMI,TIMI-UA/NSTEMI,CADILLAC and ZWOLLE,within the first 24 hours since admitted.[Results]A total of 198 acute myocardial infarction patients complicating cardiogenic shock hospitalized in our hospital from June 2014 to January 2018 were enrolled in this study,the clinical data were retrospectively analyzed.The short term mortality was observed elevated by increasing of each score,with a statistical significance.Compared with survivors,scores of APACHE Ⅱ[34(28,39)vs.21(16,26),p<0.01],APACHE III[104.5(87,121)vs.58(50,80.25),p<0.01],SAPS Ⅱ[75.5(60.25,85)vs.49(42,58.25),p<0.01],PAMI[8(6,11)vs.6(4.75,8),p<0.01],TIMI-STEMI[10(9,12)vs.9(8,10),p<0.01],TIMI-UA/NSTEMI[4(4,5)vs.3(3,4),p<0.01],CADILLAC[10(8,12)vs.7(4.5,8),p<0.01]and ZWOLLE[11(10,13)vs.11(10,12),p<0.01]in non-survivors were remarkably higher.The area under curve(AUC)of receiver operating characteristic(ROC)curve for predicting 28 days mortality of APACHE Ⅱ,APACHEⅢ,SAPS Ⅱ,PAMI,TIMI-STEMI,TIMI-UA/NSTEMI,CADILLAC and ZWOLLE scoring systems were 0.844,0.829,0.824,0.658,0.681,0.734,0.766 and 0.551,respectively.With score of item "post-procedural TIMI flow less than grade 2"doubled,we developed a new score known as CADILLAC-plus,presented with an AUCROC of 0.804,cut-off point of 9.5,sensitivity of 0.703 and a specificity of 0.757.For prediction of 28-day mortality of these patients who received coronary angiography(n=126),The AUC of ROC of APACHE Ⅱ,APACHE Ⅲ,SAPS Ⅱ,PAMI,TIMI-STEMI,TIMI-NSTEMI,CADILLAC and ZWOLLE scoring systems were 0.820,0.797,0.785,0.667,0.657,0.711,0.821 and 0.621,respectively.While AUC of ROC of CADILLAC-plus could reach as high as 0.885.The predicting efficacy of CADILLAC-plus scoring system was superior to the current scoring systems.[Conclusion]The 8 current scoring systems are all suitable for predicting theshort-term mortality in acute myocardial infarction patients complicating cardiogenic shock,and the predicting efficacy of the improved CADILLAC-plus score is superior to other scoring systems in this patient cohort.