危险休克试验与随机心源性休克试验和现实世界登记的比较分析。

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine Pub Date : 2025-11-01 Epub Date: 2025-01-24 DOI:10.1016/j.carrev.2025.01.010

Magdi Zordok , Kevin G. Buda , Muhammad Etiwy , Sourbha S. Dani , Sarju Ganatra , Babar Basir , Khaldoon Alaswad , Emmanouil S. Brilakis , Michael Megaly

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引用次数: 0

摘要

背景：丹麦-德国心源性休克（DanGer）试验报道，与标准治疗相比，经皮微轴流泵治疗stemi相关心源性休克患者的死亡率更低。目前尚不清楚危险休克试验人群与随机对照试验（rct）和现实世界研究临时机械循环支持（tMCS）对急性心肌梗死合并心源性休克（AMICS）的比较。方法：对涉及tMCS治疗AMICS的随机对照试验和注册表进行系统回顾和荟萃分析。将患者的特征和结果与危险休克试验中的患者进行比较。结果：2005 - 2023年共纳入7项随机对照试验（1201例）和10项注册表（2100例）。危险休克患者的合合症较少，血压较低，左心室射血分数（LVEF）较低，心率较高，tMCS起始时间较短（5.5±2.7 vs. 19.1±38.3 h）， p结论：尽管初始血流动力学较差，但危险休克患者的生存率更高，可能是由于合合症较少，tMCS起始时间较早，以及算法治疗方法。

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Comparative analysis of the DanGer Shock trial to randomized cardiogenic shock trials and real-world registries

Background

The Danish–German Cardiogenic (DanGer) Shock Trial reported lower mortality with a percutaneous micro-axial flow pump compared to standard care in patients with STEMI-related cardiogenic shock. It remains unclear how the DanGer Shock trial population compares to randomized controlled trials (RCTs) and real-world registries studying temporary mechanical circulatory support (tMCS) for acute myocardial infarction with cardiogenic shock (AMICS).

Methods

A systematic review and meta-analysis of RCTs and registries involving tMCS for AMICS was performed. Patient characteristics and outcomes were compared to those in the DanGer Shock Trial.

Results

From 2005 to 2023, seven RCTs (1201 patients) and ten registries (2100 patients) were analyzed. DanGer Shock patients had fewer comorbidities, lower blood pressure, lower Left ventricular ejection fraction (LVEF), higher heart rates, and shorter times to tMCS initiation (5.5 ± 2.7 vs. 19.1 ± 38.3 h, p < 0.0001) than RCT patients. They required shorter tMCS durations, less mechanical ventilation, and inotropic support. DanGer patients experienced fewer bleeding events, infections, and limb ischemia, with similar 30-day mortality but higher stroke rates. Compared to registry patients, DanGer Shock patients had fewer comorbidities but required longer tMCS, more mechanical ventilation, and inotropic support, with fewer complications and lower 30-day mortality.

Conclusion

DanGer Shock patients had better survival despite worse initial hemodynamics, possibly due to fewer comorbidities, earlier tMCS initiation, and an algorithmic treatment approach.

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来源期刊

Cardiovascular Revascularization Medicine CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

3.30

自引率

5.90%

发文量

687

审稿时长

36 days

期刊介绍： Cardiovascular Revascularization Medicine (CRM) is an international and multidisciplinary journal that publishes original laboratory and clinical investigations related to revascularization therapies in cardiovascular medicine. Cardiovascular Revascularization Medicine publishes articles related to preclinical work and molecular interventions, including angiogenesis, cell therapy, pharmacological interventions, restenosis management, and prevention, including experiments conducted in human subjects, in laboratory animals, and in vitro. Specific areas of interest include percutaneous angioplasty in coronary and peripheral arteries, intervention in structural heart disease, cardiovascular surgery, etc.