Abstract：
OBJECTIVE: To determine the influence of presenting electrocardiographic (ECG) changes on prognosis in acute coronary syndrome cardiogenic shock (ACS-CS) patients undergoing percutaneous coronary angiography (PCI).
BACKGROUND: The effect of initial ECG changes such as ST-elevation myocardial infarction (STEMI) versus non-STEMI among patients ACS-CS on prognosis remains unclear.
METHODS: We analysed data from consecutive patients with ACS-CS enrolled in the Victorian Cardiac Outcomes registry between 2014 and 2020. Inverse probability of treatment weighting analysis (IPTW) was used to assess the effect of ECG changes on 30-day mortality.
RESULTS: Of 1564 patients with ACS-CS who underwent PCI, 161 had non-STEMI and 1403 had STEMI on ECG. The mean age was 66 ± 13 years, and 74 % (1152) were males. Patients with non-STEMI compared to STEMI were older (70 ± 12 vs 65 ± 13 years), had higher rates of diabetes (34 % vs 21 %), prior coronary artery bypass graft surgery (14 % vs 3.3 %), peripheral arterial disease (10.6 % vs 4.1 %, p < 0.01), and lower baseline eGFR (53.8 [37.1, 75.4] vs 65.3 [46.3, 87.8] ml/min/1.73m2), all p ≤ 0.01. Non-STEMI patients were more likely to have a culprit left circumflex artery (29 % vs 20 %) and more often underwent multivessel percutaneous coronary intervention (30 % vs 20 %) but had lower rates of out-of-hospital cardiac arrest (21 % vs 39 %), all p ≤ 0.01. Propensity score analysis with IPTW confirmed that non-STEMI ECG was associated with lower odds for 30-day all-cause mortality (OR 0.47 [0.32, 0.69], p < 0.001), and 30-day major adverse cardiovascular and cerebrovascular events (OR 0.48 [0.33, 0.70]).
CONCLUSIONS: In patients undergoing PCI, Non-STEMI as compared to STEMI on index ECG was associated with approximately half the relative risk of both 30-day mortality and 30-day MACCE and could be a useful variable to integrate in ACS-CS risk scores.
BACKGROUND: The effect of initial ECG changes such as ST-elevation myocardial infarction (STEMI) versus non-STEMI among patients ACS-CS on prognosis remains unclear.
METHODS: We analysed data from consecutive patients with ACS-CS enrolled in the Victorian Cardiac Outcomes registry between 2014 and 2020. Inverse probability of treatment weighting analysis (IPTW) was used to assess the effect of ECG changes on 30-day mortality.
RESULTS: Of 1564 patients with ACS-CS who underwent PCI, 161 had non-STEMI and 1403 had STEMI on ECG. The mean age was 66 ± 13 years, and 74 % (1152) were males. Patients with non-STEMI compared to STEMI were older (70 ± 12 vs 65 ± 13 years), had higher rates of diabetes (34 % vs 21 %), prior coronary artery bypass graft surgery (14 % vs 3.3 %), peripheral arterial disease (10.6 % vs 4.1 %, p < 0.01), and lower baseline eGFR (53.8 [37.1, 75.4] vs 65.3 [46.3, 87.8] ml/min/1.73m2), all p ≤ 0.01. Non-STEMI patients were more likely to have a culprit left circumflex artery (29 % vs 20 %) and more often underwent multivessel percutaneous coronary intervention (30 % vs 20 %) but had lower rates of out-of-hospital cardiac arrest (21 % vs 39 %), all p ≤ 0.01. Propensity score analysis with IPTW confirmed that non-STEMI ECG was associated with lower odds for 30-day all-cause mortality (OR 0.47 [0.32, 0.69], p < 0.001), and 30-day major adverse cardiovascular and cerebrovascular events (OR 0.48 [0.33, 0.70]).
CONCLUSIONS: In patients undergoing PCI, Non-STEMI as compared to STEMI on index ECG was associated with approximately half the relative risk of both 30-day mortality and 30-day MACCE and could be a useful variable to integrate in ACS-CS risk scores.
摘要：
目的：探讨急性冠脉综合征心源性休克(ACS-CS)患者经皮冠状动脉造影(PCI)后心电图(ECG)改变对预后的影响。
背景：ACS-CS患者的ST段抬高型心肌梗死（STEMI）和非STEMI等初始心电图改变对预后的影响尚不清楚。
方法：我们分析了2014年至2020年在维多利亚州心脏结果登记处登记的连续ACS-CS患者的数据。使用治疗加权分析的逆概率(IPTW)来评估ECG变化对30天死亡率的影响。
结果：在接受PCI的1564例ACS-CS患者中，有161例非STEMI，1403例有STEMI。平均年龄66±13岁,74%(1152)为男性。与STEMI相比，非STEMI患者年龄较大（70±12vs65±13岁），糖尿病发病率较高（34%vs21%），既往冠状动脉旁路移植手术(14%vs3.3%)，外周动脉疾病（10.6%vs4.1%，p<0.01),和较低的基线eGFR（53.8[37.1,75.4]对65.3[46.3,87.8]ml/min/1.73m2），所有p≤0.01。非STEMI患者更可能有罪犯左回旋动脉（29％比20％），更经常接受多支血管经皮冠状动脉介入治疗（30％比20％），但院外心脏骤停的发生率较低（21％比39％），所有p≤0.01。IPTW的倾向评分分析证实，非STEMI心电图与30天全因死亡率的较低几率相关（OR0.47[0.32,0.69]，p<0.001)，和30天主要不良心脑血管事件（OR0.48[0.33,0.70]）。
结论：在接受PCI的患者中，与指标心电图上的STEMI相比，非STEMI与30天死亡率和30天MACCE的相对风险的大约一半相关，并且可能是纳入ACS-CS风险评分的有用变量。
背景：ACS-CS患者的ST段抬高型心肌梗死（STEMI）和非STEMI等初始心电图改变对预后的影响尚不清楚。
方法：我们分析了2014年至2020年在维多利亚州心脏结果登记处登记的连续ACS-CS患者的数据。使用治疗加权分析的逆概率(IPTW)来评估ECG变化对30天死亡率的影响。
结果：在接受PCI的1564例ACS-CS患者中，有161例非STEMI，1403例有STEMI。平均年龄66±13岁,74%(1152)为男性。与STEMI相比，非STEMI患者年龄较大（70±12vs65±13岁），糖尿病发病率较高（34%vs21%），既往冠状动脉旁路移植手术(14%vs3.3%)，外周动脉疾病（10.6%vs4.1%，p<0.01),和较低的基线eGFR（53.8[37.1,75.4]对65.3[46.3,87.8]ml/min/1.73m2），所有p≤0.01。非STEMI患者更可能有罪犯左回旋动脉（29％比20％），更经常接受多支血管经皮冠状动脉介入治疗（30％比20％），但院外心脏骤停的发生率较低（21％比39％），所有p≤0.01。IPTW的倾向评分分析证实，非STEMI心电图与30天全因死亡率的较低几率相关（OR0.47[0.32,0.69]，p<0.001)，和30天主要不良心脑血管事件（OR0.48[0.33,0.70]）。
结论：在接受PCI的患者中，与指标心电图上的STEMI相比，非STEMI与30天死亡率和30天MACCE的相对风险的大约一半相关，并且可能是纳入ACS-CS风险评分的有用变量。
