| 1 | Percutaneous assist devices in acute myocardial infarction with cardiogenic shock: Review, meta-analysis显示文摘AIM: To assess the impact of percutaneous cardiac support in cardiogenic shock(CS) complicating acute myocardial infarction(AMI), treated with percutaneous coronary intervention. METHODS: We selected all of the studies published from January 1st, 1997 to May 15 st, 2015 that compared the following percutaneous mechanical support in patients with CS due to AMI undergoing myocardial revascularization:(1) intra-aortic balloon pump(IABP) vs Medical therapy;(2) percutaneous left ventricular assist devices(PLVADs) vs IABP;(3) complete extracorporeal life support with extracorporeal membrane oxygenation(ECMO) plus IABP vs IABP alone; and(4) ECMO plus IABP vs ECMO alone, in patients with AMI and CS undergoing myocardial revascularization. We evaluated the impact of the support devices on primary and secondary endpoints. Primary endpoint was the inhospital mortality due to any cause during the same hospital stay and secondary endpoint late mortality at 6-12 moof follow-up. RESULTS: One thousand two hundred and seventytwo studies met the initial screening criteria. After detailed review, only 30 were selected. There were 6 eligible randomized controlled trials and 24 eligible observational studies totaling 15799 patients. We found that the inhospital mortality was:(1) significantly higher with IABP support vs medical therapy(RR = +15%, P = 0.0002);(2) was higher, although not significantly, with PLVADs compared to IABP(RR = +14%, P = 0.21); and(3) significantly lower in patients treated with ECMO plus IABP vs IABP(RR =-44%, P = 0.0008) or ECMO(RR =-20%, P = 0.006) alone. In addition, Trial Sequential Analysis showed that in the comparison of IABP vs medical therapy, the sample size was adequate to demonstrate a significant increase in risk due to IABP. CONCLUSION: Inhospital mortality was significantly higher with IABP vs medical therapy. PLVADs did not reduce early mortality. ECMO plus IABP significantly reduced inhospital mortality compared to IABP. | Francesco Romeo Maria Cristina Acconcia Domenico Sergi Alessia Romeo Simona Francioni Flavia Chiarotti Quintilio Caretta | 2016 | World Journal of Cardiology2016，8，1： | 29 |
| 2 | ST段抬高型心肌梗死患者院内发生持续性室性心动过速/心室颤动的临床特点及其影响因素研究显示文摘目的分析ST段抬高型心肌梗死(STEMI)患者院内发生持续性室性心动过速(SVT)/心室颤动(VF)的临床特点及其影响因素。方法连续收集2011年8月—2013年8月首都医科大学附属北京安贞医院心内科监护病房收治的STEMI患者2 343例,入院后连续心电监测72 h以上,按照是否发生院内SVT/VF分为SVT/VF组(n=183)和无SVT/VF组(n=2 160)。回顾性分析两组患者的临床资料,记录其一般资料、实验室检查指标、冠状动脉病变及急诊血运重建情况、院内治疗情况、院内临床事件发生情况及TIMI危险评分,并采用多因素二分类logistic回归分析筛选STEMI患者院内发生SVT/VF的影响因素。结果两组患者年龄、吸烟率、高血压病史阳性率、糖尿病病史阳性率、脑血管疾病病史阳性率、陈旧性心肌梗死病史阳性率、经皮冠状动脉介入治疗(PCI)史阳性率、冠状动脉旁路移植术(CABG)史阳性率、发病至入院时间比较,差异均无统计学意义(P>0.05);SVT/VF组患者男性所占比例、冠心病家族史阳性率、心率、Killip分级Ⅲ~Ⅳ级者所占比例及左心室射血分数≤35%者所占比例高于无SVT/VF组,收缩压和舒张压低于无SVT/VF组(P<0.05)。SVT/VF组患者血红蛋白水平、中性粒细胞分数、肌酸激酶同工酶水平及估算肾小球滤过率(eGFR)<60 ml·min^(-1)·(1.73 m^2)^(-1)者所占比例高于无SVT/VF组(P<0.05);两组患者肌钙蛋白I水平、血清K^+≤3.5mmol/L者所占比例及低密度脂蛋白水平比较,差异无统计学意义(P>0.05)。SVT/VF组患者共142例完成急诊冠状动脉造影,无SVT/VF组患者共1 171例完成急诊冠状动脉造影,其中SVT/VF组患者左主干病变发生率高于无SVT/VF组、左回旋支病变发生率低于无SVT/VF组(P<0.05);两组患者左前降支、右冠状动脉病变及血管狭窄70%以上≥2支发生率比较,差异无统计学意义(P>0.05)。SVT/VF组患者前壁梗死发生率和行急诊PCI者所占比例率高于非SVT/VF组(P<0.05);两组患者下壁/右室梗死发生率比较,差异无统计学意义(P>0.05)。两组患者无一例行急诊CABG。SVT/VF组患者行静脉溶栓者所占比例、利尿剂使用率、血管活性药物使用率、行主动脉内球囊反搏(IABP)辅助治疗及持续肾脏替代治疗者所占比例高于非SVT/VF组,β-受体阻滞剂使用率低于非SVT/VF组,β-受体阻滞剂开始使用时间晚于非SVT/VF组(P<0.05);两组患者阿司匹林、二磷酸腺苷(ADP)受体抑制剂、血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体阻滞剂(ACEI/ARB)、硝酸酯类药物使用率及住院时间比较,差异无统计学意义(P>0.05)。A组患者心源性休克发生率和院内病死率均高于B组(P<0.05)。SVT/VF组患者TIMI危险评分高于非SVT/VF组,TIMI危险评分为8~14分者院内SVT/VF发生率高于TIMI危险评分为0~7分者(P<0.05)。多因素二分类logistic回归分析结果显示,左心室射血分数≤35%〔OR=3.58,95%CI(2.36,5.44)〕、e GFR<60 ml·min^(-1)·(1.73 m^2)^(-1)〔OR=3.30,95%CI(2.36,4.63)〕、行急诊PCI〔OR=2.92,95%CI(2.05,4.18)〕及TIMI危险评分为8~14分〔OR=5.96,95%CI(4.03,8.80)〕是STEMI患者发生院内SVT/VF的危险因素,使用β-受体阻滞剂〔OR=0.55,95%CI(20.40,0.76)〕是STEMI患者发生院内SVT/VF的保护因素(P<0.05)。结论院内发生SVT/VF的STEMI患者多为男性,入院时心率快、血压低,心肾功能差,心源性休克及死亡发生风险高。使用β-受体阻滞剂的STEMI患者院内SVT/VF发生率较低,且心肾功能差、行急诊PCI及TIMI危险评分为8~14分的STEMI患者院内SVT/VF发生率较高,应引起临床重视。 | 姚靖 刘文娴 曹佳宁 | 2016 | 实用心脑肺血管病杂志2016，24，5： | 4 |
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