Abstract
The aim. To study the risk factors for hospital mortality in patients with acute coronary syndrome with ST-segment elevation (STEACS) complicated by cardiogenic shock (CS).Materials and methods. A total of 104 patients with STEACS complicated by CS were studied. The follow-up group (group I) included 58 (55,8%) patients who died in hospital (mean age 71,8±7,31 years), the comparison group (group II) – 46 patients, who have been treated and discharged (mean age 59,5±6,18 years). All patients underwent general clinical studies, the level of troponins, lipids, glucose, creatinine in plasma was determined, electrocardiography and echocardiography were performed. Coronary angiography and percutaneous coronary intervention (PCI) were urgently performed. The method of binary logistic regression with the determination of the odds ratio and its 95% confidence interval for each reliable variable was used to identify risk factors for hospital mortality.Results. In group I patients with CS, compared with group II, patients over the age of 70 (32 (55,2%) vs 10 (22,7%), р=0,0004), with concomitant chronic kidney disease (32 (55,2%) vs 9 (19,6%), p=0,0002), postinfarction cardiosclerosis (30 (51,7%) vs 9 (19,6%), р=0,001) and chronic heart failure of III-IV functional class (32 (55,1%) vs 11 (23,9%), p=0,001) were significantly more often observed. Baseline levels of plasma leukocytes, troponin and creatinine were significantly higher in deceased patients with CS. Left ventricular ejection fraction below 40% was observed more often in the follow-up group than in the comparison group (46 (79,3%) vs 27 (58,7%), p=0,022). In group I, compared with group II, there was a higher incidence of three-vessel coronary lesions (36 (75%) vs 12 (26,1%), p=0,0001) and chronic coronary artery occlusion unrelated to STEACS (25 (52,1%) vs 12 (26,1%), р=0,009). The same trend was observed when assessing the average number of stenoses and occlusions of the coronary arteries. PCI was performed in 43 (74,1%) of the deceased and 43 (93,5%) of the surviving STEACS patients with CS (p=0,009). The follow-up group had a higher rate of unsuccessful PCI (30,2%) vs 3 (7%), р=0,001) and performed later than 6 hours after the onset of an angina attack (28 (65,1%) vs 6 (14%), р=0,0001).Summary. Hospital mortality in patients with STEMI complicated by CS was associated with the presence left ventricular ejection fraction less than 40%, three-vessel coronary lesion and performing PCI later than 6 hours from the beginning of the pain attack.
Highlights
In group I, compared with group II, there was a higher incidence of three-vessel coronary lesions (36 (75%) vs 12 (26,1%), p=0,0001) and chronic coronary artery occlusion unrelated to STEACS (25 (52,1%) vs 12 (26,1%), р=0,009)
Hospital mortality in patients with STEMI complicated by CS was associated with the presence left ventricular ejection fraction less than 40%, three-vessel coronary lesion and performing PCI later than 6 hours from the beginning of the pain attack
Initial сomparative characteristics of patients with acute coronary syndrome with SТ-segment elevation complicated by cardiogenic shock
Summary
ФГБОУ ВО «Ивановская государственная медицинская академия» Минздрава России, кафедра внутренних болезней и фтизиатрии, Иваново, Россия. ФАКТОРЫ РИСКА ГОСПИТАЛЬНОЙ ЛЕТАЛЬНОСТИ ПРИ ОСТРОМ КОРОНАРНОМ СИНДРОМЕ С ПОДЪЕМОМ СЕГМЕНТА ST, ОСЛОЖНЕННОМ КАРДИОГЕННЫМ ШОКОМ. Изучить факторы риска госпитальной летальности у больных острым коронарным синдромом с подъемом сегмента ST (ОКСпST), осложненным кардиогенным шоком (КШ). В I группе, по сравнению со II группой, была выше частота трехсосудистого поражения венечного русла (36 (75%) vs 12 (26,1%), p=0,0001) и хронической окклюзии коронарной артерии, несвязанной с ОКСпST (25 (52,1%) vs 12 (26,1%), р=0,009). В группе наблюдения, чем в группе сравнения, была выше частота безуспешного ЧКВ (13 (30,2%) vs 3 (7%), р=0,001) и проведенного позднее 6 часов от начала ангинозного приступа (28 (65,1%) vs 6 (14%), р=0,0001). Госпитальная летальность у больных ОКСпST, осложненным КШ, ассоциировалась с наличием у них фракции выброса левого желудочка менее 40%, трехсосудистого поражения коронарного русла и проведением ЧКВ позднее 6 часов от начала болевого приступа. Ключевые слова: кардиогенный шок, острый коронарный синдром с подъемом сегмента ST, госпитальная летальность, факторы риска, предикторы, прогноз
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