Cardiogenic shock complicating acute myocardial infarction in elderly patients: Does admission to a tertiary center improve survival?

作     者：Berger, AK Radford, MJ Krumholz, HM 

作者机构：Yale Univ Sch Med Dept Med Sect Cardiovasc Med New Haven CT 06520 USA Yale Univ Sch Med Dept Epidemiol & Publ Hlth Sect Hlth Policy & Adm New Haven CT 06520 USA Yale New Haven Med Ctr Ctr Outcomes Res & Evaluat New Haven CT 06504 USA Qualidigm Middletown CT USA 

出 版 物：《AMERICAN HEART JOURNAL》 (美国心脏杂志)

年 卷 期：2002年第143卷第5期

页      面：768-776页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：队列研究 冠状动脉分流术/统计学和数值数据 冠心病重症监护病房 数据库 事实型 住院 心肌梗死/并发症 心肌梗死/死亡率 心肌梗死/治疗 心肌血管重建术/死亡率 心肌血管重建术/利用 比值比 预后 休克 心原性/并发症 休克 心原性/死亡率 休克 心原性/治疗 女(雌)性 人类 男(雄)性 

摘      要：Background The role of early revascularization among patients with acute myocardial infarction complicated by cardiogenic shock remains controversial. Angioplasty registries, while suggesting a benefit, are subject to selection bias, and clinical trials have been underpowered to detect early benefits. If an invasive strategy is beneficial in this population, patients admitted to hospitals with onsite coronary revascularization might be expected to have a better prognosis. We sought to determine whether access to cardiovascular resources at the admitting hospital influenced the prognosis of patients with acute myocardial infarction complicated by cardiogenic shock. Methods By use of the Cooperative Cardiovascular Project database (a retrospective medical record review of Medicare patients discharged with acute myocardial infarction), we identified patients aged greater than or equal to65 years whose myocardial infarction was complicated by cardiogenic shock. Results Of the 601 patients with cardiogenic shock, 287 (47.8%) were admitted to hospitals without revascularization services and 3 14 (52.2%) were admitted to hospitals with coronary angioplasty and coronary artery bypass surgery facilities. Clinical characteristics were similar across the subgroups. Patients admitted to hospitals with revascularization services were more likely to undergo coronary revascularization during the index hospitalization and during the first month after acute myocardial infarction. After adjustment for demographic, clinical, hospital, and treatment strategies, the presence of onsite revascularization services was not associated with a significantly lower 30-day (odds ratio 0.83, 95% CI 0.47, 1.45) or 1-year mortality (odds ratio 0.91, 95% CI 0.49, 1.72). Conclusions In a community-based cohort, patients with acute myocardial infarction complicated by cardiogenic shock did not have significantly different adjusted 30-day and 1-year mortality, irrespective of the revascularization capab