Short-term Prognosis And Risk Factors Analysis Of Acute ST-segment Elevation Myocardial Infarction Complicated By Cardiogenic Shock

Research background and objective: Cardiogenic shock occurs in up to 10% of patients with acute ST-segment elevation myocardial infarction(STEMI),and inhospital mortality can be as high as 50% or more.Although there has been a significant improvement in the treatment of these patients over the past decade,including primary percutaneous coronary intervention(PCI)and the use of mechanical circulatory,cardiogenic shock is still the important cause in STEMI patients of high mortality,in particular,the highest mortality in 30 days.This article studies the short-term prognosis and related factors in STEMI patients with cardiogenic shock under the current medical conditions.Methods: This is a single-center clinical retrospective observation study,retrospective analysis of patients with STEMI complicated by CS who visited our center from January 2007 to December 2016,retrospectively analyzed the clinical data of the patients by using an in-hospital case retrieval system and followed up by telephone way,the deadline is January 2018,there is a total of 322 patients..The endpoint was all-cause death over 30 days.Research Results:1.Baseline data: sex,time to onset of symptoms,heart rate,history of hypertension,history of diabetes mellitus,previous history of myocardial infarction,history of heart failure,history of stroke,whether anterior myocardial infarction,hyperlipidemia,whether use of IABP there is no difference in 30 days mortality.The mortality was significantly higher in patients aged ?75 years than in patients age <75 years(77% / 61.5%,P = 0.004).The mortality of smoking higher than those without smoking(71.3%/54.3%,P=0.006).The mortality of patients with GFR <60ml / min was higher than that of patients with GFR?60ml / min(83.3% / 57.3%,P <0.001).The mortality of patients with late cardiogenic shock was higher than that of early cardiogenic shock(78.8%/50.8%,P<0.001).The mortality rate of conservative treatment was higher than that of PCI(81.9% / 38.8%,P <0.001).Among them,78 were direct PCI,with a mortality rate of 41%,elective PCI was performed in 25 patients with a mortality rate of 32.2.Multivariate analysis was performed on the primary endpoint(short term mortality)of STEMI patients with CS: elder(age?75)(OR: 1.80,95% CI: 1.02-3.41,P = 0.048),renal insufficiency(GFR <60 ml / min=(OR:3.49,95% CI: 1.41-8.60,P = 0.007),late cardiogenic shock(OR: 3.49,95% CI: 1.89-6.49,P <0.001)are independent risk factors for the primary endpoint of STEMI with cardiogenic shock.PCI(OR:0.15,95%CI:0.08-0.28,P<0.001)was a protective factor for the primary end point in patients with STEMI complicated by shock.3.Interventional subgroup analysis: Short-term mortality was 78% in the group of PCI.78 cases receiving direct PCI(41%,32/78).Univariar and multivariate analyzes results showed that smokers,renal insufficiency,and late shock have a high risk when receiving direct PCI(P <0.05).Age,gender,onset of symptoms,history of hypertension,history of diabetes,history of smoking,previous history of myocardial infarction,history of stroke,history of heart failure,cardiac insufficiency,classification of lesions,and IABP implantation were not significantly associated with patient mortality All <0.05).Late shock(OR: 23.47,95% CI: 4.87-113.23,P <0.001)is an independent risk factor of death for the STEMI complicated by cardiogenic shock patients who receiving direct PCI.4.Occurrence time of cardiogenic shock subgroup analysis: Compare early cardiogenic shock and late cardiogenic shock:The incidence of symptoms in late shock(> 6 hours)patients was higher than that in early shock patients(55.1% / 38.4%,P <0.001).The proportion of patients with diabetes mellitus in late shock is higher than that of early shock(39.5% / 29.1%,P0.040).The proportion of patients with heart failure in late cardiogenic was higher than early shock(5.5%/1.3%,P0.046).Research Conclusion: 1.STEMI complicated by CS mortality is as high as 68.3%,compared with early CS,late CS patients with higher mortality.2.The elderly(age?75),renal insufficiency(GFR <60ml/min)are independent risk factors for STEMI complicated by cardiogenic shock,increasing the short-term mortality of patients.3.PCI treatment can significantly improve the short-term prognosis of STEMI complicated by cardiogenic shock,However,mortality in patients with late cardiogenic shock is still higher in patients with PCI.