■急性机械循环支持(aMCS)在伴有心源性休克(CS)的应激性心肌病(SIC)患者中的作用尚未得到很好的研究。这里,我们使用大型国家数据库描述了SIC-CS中使用aMCS的发生率和结局.
■使用2016年1月至2019年11月的全国再入院数据库,我们确定了接受孤立性主动脉内球囊反搏(IABP)的SIC住院患者,微轴流泵(Impella,Abiomed),或指征住院期间的体外膜氧合(ECMO)。
■在索引住院期间,在94,709例SIC(1.0%)住院中,共有902例需要aMCS:611例具有IABP(67.7%),189人患有Impella(21.0%),102人患有ECMO(11.3%)。ECMO或Impella患者的住院死亡率高于IABP患者(37.3%vs29.1%vs18.5%,分别)。Impella调整后住院死亡风险增加(调整后优势比[aOR],1.98;95%CI,1.12-3.49)和ECMO(aOR,4.15;95%CI,1.85-9.32)与IABP。与IABP相比,Impella与30天再入院的调整风险增加相关(aOR,2.53;95%CI,1.16-5.51)。与接受IABP的患者相比,接受ECMO或Impella的患者肾脏替代治疗和血管/出血并发症的发生率更高。
■在使用管理数据库的全国性分析中,接受ECMO和Impella的患者住院死亡率较高,肾脏替代疗法,与接受IABP的患者相比,血管/出血并发症。合并症较多的患者可能会接受更积极的血流动力学支持,这可能是观察到的死亡率差异的原因。未来的前瞻性研究需要客观和普遍地描述继发于SIC的CS患者的基线临床和血流动力学特征。
UNASSIGNED: The role of acute mechanical circulatory support (aMCS) in patients with stress-induced cardiomyopathy (SIC) complicated by cardiogenic shock (CS) is not well studied. Here, we describe the incidence and outcomes of aMCS use in SIC-CS using a large national database.
UNASSIGNED: Using the Nationwide Readmissions Database from January 2016 to November 2019, we identified patients hospitalized with SIC who received isolated intra-aortic balloon pump (IABP), microaxial flow pump (Impella, Abiomed), or extracorporeal membrane oxygenation (ECMO) during the index hospitalization.
UNASSIGNED: A total of 902 among 94,709 hospitalizations for SIC (1.0%) required aMCS during the index hospitalization: 611 had IABP (67.7%), 189 had Impella (21.0%) and 102 had ECMO (11.3%). Patients with ECMO or Impella had higher in-hospital mortality rates than those with IABP (37.3% vs 29.1% vs 18.5%, respectively). There was an increased adjusted risk of in-hospital death with Impella (adjusted odds ratio [aOR], 1.98; 95% CI, 1.12-3.49) and ECMO (aOR, 4.15; 95% CI, 1.85-9.32) vs IABP. Impella was associated with an increased adjusted risk of 30-day readmission compared to IABP (aOR, 2.53; 95% CI, 1.16-5.51). Patients with ECMO or Impella had a higher incidence of renal replacement therapy and vascular/bleeding complications compared to those who received IABP.
UNASSIGNED: In this nationwide analysis using an administrative database, patients who received ECMO and Impella showed higher rates of in-hospital mortality, renal replacement therapy, and vascular/bleeding complications compared to those who received IABP. Patients with more comorbidities may receive more aggressive hemodynamic support which may account for observed mortality differences. Future prospective studies with objective and universal characterization of baseline clinical and hemodynamic characteristics of patients with CS secondary to SIC are needed.