主动脉内球囊反搏休克Ⅱ评分对老年人急性心肌梗死合并心源性休克短期预后的预测价值

目的观察主动脉内球囊反搏休克Ⅱ(IABP-SHOCKⅡ)评分对老年急性心肌梗死(AMI)合并心源性休克(CS)的30 d病死率的预测价值。方法本研究为单中心回顾性队列研究。分析2010年1月至2019年1月我院收治的138例老年AMI合并CS且置入IABP患者的临床资料。根据IABP-SHOCKⅡ评分分为低危组(评分0~2分,72例)、中危组(评分3~4分,39例)和高危组(评分5~9分,27例),比较3组患者的基线资料和药物、介入和IABP等治疗情况,Kaplan-Meier生存曲线分析3组患者的短期死亡情况,受试者工作特征曲线(ROC)评估IABP-SHOCKⅡ对30 d病死率的预测价值。结果138例患者中,男性71例(51.4%)。中危组和高危组患者与低危组患者比较年龄、左心室舒张末期内径、左心室收缩末期内径、左心室射血分数、心率、血压、肌钙蛋白水平、血肌酐、尿素氮、B型利钠肽、乳酸、Gensini评分、心肌梗死溶栓试验(TIMI)血流无复流率、有创通气和床旁血滤应用率差异有统计学意义(均P<0.05)。随访30 d,低危组、中危组和高危组患者死亡分别为25例(34.7%)、20例(51.3%)和23例(85.2%),Kaplan-Meier生存曲线和Log-rank检验结果显示,3组患者死亡差异有统计学意义(χ2=30.07,P<0.01)。ROC曲线显示IABP-SHOCKⅡ评分预测30 d死亡的敏感度为80.4%,特异度为87.1%,曲线下面积分别为0.813(95%CI:0.702~0.942,P<0.01)。结论IABP-SHOCKⅡ评分可有助于对老年AMI合并CS患者IABP置入术后的短期危险分层。

Predictive value of the intra-aortic balloon counterpulsation-shockⅡscore in the short-term prognosis of acute myocardial infarction complicated by cardiogenic shock in elderly patients

Objective To examine the predictive value of the intra-aortic balloon counterpulsation-shockⅡ(IABP-SHOCKⅡ)score for 30-day mortality of acute myocardial infarction(AMI)complicated by cardiogenic shock(CS)in elderly patients.Methods Clinical data of 138 elderly patients with AMI complicated by CS admitted to our hospital and undergone IABP from January 2010 to January 2019 were retrospectively analyzed.According to the IABP-SHOCKⅡscore,they were divided into a low-risk group(scoring 0 to 2 points,72 cases),a middle-risk group(scoring 3 to 4 points,39 cases)and a high-risk group(scoring 5 to 9 points,27 cases).Baseline data,drug therapy,interventional therapy,and IABP were used in the three groups.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of IABP-SHOCKⅡfor 30-day mortality.Results Of the 138 patients,71(51.4%)were male.There were significant differences in age,left ventricular end-diastolic diameter,left ventricular ejection fraction,levels of troponin,serum creatinine,urea nitrogen,B-type natriuretic peptide and lactic acid,Gensini score,rate of thrombolysis in myocardia infarction(TIMI)no-reflow,and rates of IABP insertion,invasive ventilation and bedside hemofiltration between the intermediate-risk group and the low-risk group and between the high-risk group and the low-risk group(each P<0.05).During hospitalization,proportions of patients receiving vasoactive drugs such as norepinephrine and dopamine in the three groups were similar(each P>0.05).After 30 days of follow-up,25 patients(34.7%),20 patients(51.3%),and 23 patients(85.2%)died in the low-risk group,the intermediate-risk group,and the high-risk group,respectively,with the Kaplan-Meier survival curve and the log-rank test showing statistically significant differences between the death rates(χ2=20.09,P<0.01).The ROC curve showed that the area under the curve was 0.883(95%CI:0.702~0.942,P<0.01).Conclusions The IABP-SHOCKⅡscore may be used for short-term risk stratification after IABP implantation in elderly patients with AMI and CS.