曾繁芳,何松坚,胡伟,王小庆,闫少迪,陈怡粤,房子熙,郭文钦,罗颖,宋莉,颜红兵

• 1:中国医学科学院阜外医院深圳医院心内科
• 2:国家心血管病中心北京协和医学院中国医学科学院阜外医院冠心病中心

摘要(Abstract)：

目的 评价修订版美国心血管造影和介入学会（SCAI）休克分类对真实世界中急性心肌梗死合并心原性休克（AMICS）的应用价值。方法 回顾性收集2019年1月1日至2021年12月31日中国医学科学院阜外医院深圳医院收治的确诊为急性心肌梗死（AMI）的患者病历资料，根据传统休克和2019年及修订版的SCAI休克分类标准分析符合AMICS诊断的患者，并进行分期，分析患者临床特征、干预措施及预后。结果 960例AMI患者中，符合传统休克诊断的有38例（3.96%），出院30d内死亡21例（55.26%）。2019版和修订版SCAI休克分类的AMICS均有104例（10.83%），从A到E期分期一致，分别有32.69%、25.96%、19.23%、10.58%和11.54%。相应各期的出院30d内死亡例数分别为1例（2.94%）、0例、3例（15.00%）、8例（72.73%）、12例（100.00%）。血运重建组86例（82.69%），总死亡率17.44%,A至E期死亡率分别为0、0、16.67%、71.43%、100.00%。非血运重建患者17例，死亡8例，死亡率47.06%。冠状动脉病变方面，A/B期单支病变占比更高；E/D期三支病变占比较高。随着SCAI休克分期的递增，使用血管活性药、机械通气、主动脉内球囊反搏（IABP）使用均增加（均P<0.001）。B期患者使用血管活性药占比77.78%，出院30d死亡率均为0。C期IABP组死亡率0，非IABP组死亡率42.86%，而D期和E期使用IABP与否未见差异。C/D期使用体外膜肺氧合较E期的好。结论 修订版的SCAI休克分类更能早期识别AMICS患者，并有较强的预后预测能力；不同的SCAI休克分期可以有不同的干预措施。

关键词(KeyWords)： 急性心肌梗死;心原性休克;美国心血管造影和介入学会;休克分类

Abstract:

Keywords:

基金项目(Foundation): 国家心血管疾病临床医学研究中心深圳自主课题（NCRCSZ-2023-006）

作者(Author): 曾繁芳,何松坚,胡伟,王小庆,闫少迪,陈怡粤,房子熙,郭文钦,罗颖,宋莉,颜红兵

参考文献(References)：

• [1] van Diepen S, Katz JN, Albert NM, et al. Contemporary management of cardiogenic shock:a scientific statement from the American Heart Association[J]. Circulation, 2017,136(16):e232-e268. DOI:10.1161/CIR.0000000000000525.
• [2] Vahdatpour C, Collins D, Goldberg S. Cardiogenic shock[J].J Am Heart Assoc, 2019,8(8):e011991. DOI:10.1161/JAHA.119.011991.
• [3] Hochman JS, Sleeper LA, Webb JG, et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock.SHOCK Investigators. Should we emergently revascularize occluded coronaries for cardiogenic shock[J]. N Engl J Med, 1999,341(9):625-634. DOI:10.1056/NEJM199908263410901.
• [4] Thiele H, Zeymer U, Neumann FJ, et al. Intraaortic balloon support for myocardial infarction with cardiogenic shock[J]. N Engl J Med, 2012,367(14):1287-1296. DOI:10.1056/NEJMoa1208410.
• [5] Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure:the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology(ESC)Developed with the special contribution of the Heart Failure Association(HFA)of the ESC[J].Eur Heart J, 2016,37(27):2129-2200. DOI:10.1093/eurheartj/ehw128.
• [6] Samsky MD,Morrow DA,Proudfoot A,et al. Cardiogenic shock after acute myocardial infarction:a review[J]. JAMA,2021,326(18):1840-1850. DOI:10. 1001/jama.2021.18323.
• [7] Baran DA, Grines CL, Bailey S, et al. SCAI clinical expert consensus statement on the classification of cardiogenic shock:This document was endorsed by the American College of Cardiology(ACC), the American Heart Association(AHA), the Society of Critical Care Medicine(SCCM),and the Society of thoracic Surgeons(STS)in April 2019[J].Catheter Cardiovasc Interv, 2019,94(1):29-37. DOI:10.1002/ccd.28329.
• [8]单增卓嘎，赵志峰，陈茂. SCAI心源性休克分类法对CICU心源性休克患者死亡风险的预测价值[J].四川大学学报（医学版），2021,52(3):503-509. DOI:10.12182/20210560104.
• [9] Naidu SS, Baran DA, Jentzer JC, et al. SCAI SHOCK stage classification expert consensus update:a review and incorporation of validation studies:this statement was endorsed by the American College of Cardiology(ACC),American College of Emergency Physicians(ACEP),American Heart Association(AHA), European Society of Cardiology(ESC)Association for Acute Cardiovascular Care(ACVC), International Society for Heart and Lung Transplantation(ISHLT), Society of Critical Care Medicine(SCCM), and Society of Thoracic Surgeons(STS)in December 2021[J]. J Am Coll Cardiol, 2022,79(9):933-946. DOI:10.1016/j.jacc.2022.01.018.
• [10] Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction(2018)[J]. J Am Coll Cardiol, 2018,72(18):2231-2264. DOI:10.1016/j.jacc.2018.08.1038.
• [11] Schrage B, Dabboura S, Yan I, et al. Application of the SCAI classifi cation in a cohort of patients with cardiogenic shock[J].Catheter Cardiovasc Interv, 2020,96(3):E213-E219.DOI:10.1002/ccd.28707.
• [12] Baran DA, Long A, Badiye AP, et al. Prospective validation of the SCAI shock classification:single center analysis[J].Catheter Cardiovasc Interv, 2020,96(7):1339-1347.DOI:10.1002/ccd.29319.
• [13] Pareek N, Dworakowski R, Webb I, et al. SCAI cardiogenic shock classification after out of hospital cardiac arrest and association with outcome[J]. Catheter Cardiovasc Interv,2021,97(3):E288-E297. DOI:10.1002/ccd.28984.
• [14] Jentzer JC, van Diepen S, Barsness GW, et al. Cardiogenic shock classification to predict mortality in the cardiac intensive care unit[J]. J Am Coll Cardiol,2019,74(17):2117-2128. DOI:10.1016/j.jacc.2019.07.077.
• [15] Geller BJ, Sinha SS, Kapur NK, et al. Escalating a n d de-escalating temporary mechanical circulatory support in cardiogenic shock:a scientific statement from the American Heart Association[J]. Circulation,2022,146(6):e50-e68. DOI:10.1161/CIR.0000000000001076.
• [16] Basir MB, Kapur NK, Patel K, et al. Improved outcomes associated with the use of shock protocols:updates from the national cardiogenic shock initiative[J]. Catheter Cardiovasc Interv,2019,93(7):1173-1183. DOI:10.1002/ccd.28307.
• [17] Hanson ID, Tagami T, Mando R, et al. SCAI shock classification in acute myocardial infarction:insights from the national cardiogenic shock initiative[J]. Catheter Cardiovasc Interv, 2020,96(6):1137-1142. DOI:10.1002/ccd.29139.
• [18] Lawler PR, Berg DD, Park JG, et al. The range of cardiogenic shock survival by clinical stage:data from the critical care cardiology trials network registry[J]. Crit Care Med,2021,49(8):1293-1302. DOI:10.1097/CCM.0000000000004948.
• [19] Olarte N, Rivera NT, Grazette L. Evolving presentation of cardiogenic shock:a review of the medical literature and current practices[J]. Cardiol Ther,2022,11(3):369-384.DOI:10.1007/s40119-022-00274-6.
• [20] Ostadal P, Rokyta R, Karasek J, et al. Extracorporeal membrane oxygenation in the therapy of cardiogenic shock:results of the ECMO-CS randomized clinical trial[J].Circulation,2022,147(6):454-464.DOI:10.1161/CIRCULATIONAHA.122.062949.
• [21] Yaling H. Chinese expert consensus on clinical application of percutaneous mechanical circulatory support devices in interventional therapy for patients with complex cardiovascular disease[J]. Eur Heart J, 2023,3:ehad009. DOI:10.1093/eurheartj/ehad009.
• [22] Basir MB, Schreiber TL, Grines CL, et al. Effect of early initiation of mechanical circulatory support on survival in cardiogenic shock[J]. Am J Cardiol,2017,119(6):845-851. DOI:10.1016/j.amjcard.2016.11.037.
• [23] Papolos AI, Kenigsberg BB, Berg DD, et al. Management and outcomes of cardiogenic shock in cardiac icus with versus without shock teams[J]. J Am Coll Cardiol,2021,78(13):1309-1317. DOI:10.1016/j.jacc.2021.07.044.
• [24] Henry TD, Tomey MI, Tamis-Holland JE, et al. Invasive management of acute myocardial infarction complicated by cardiogenic shock:a scientific statement from the American Heart Association[J]. Circulation,2021,143(15):e815-e829. DOI:10.1161/CIR.0000000000000959.