{"title":"左心室大小与左主干冠状动脉梗死合并心源性休克患者预后的关系","authors":"Naoki Tadokoro, Satoshi Kainuma, Kimito Minami, Satsuki Fukushima","doi":"10.1111/aor.14974","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Cardiogenic shock in left main coronary artery acute myocardial infarction patients has high mortality rates. This study investigates the association between left ventricular size and outcomes in these patients treated with veno-arterial extracorporeal membrane oxygenation.</p><p><strong>Methods: </strong>This retrospective single-center study examined patients who underwent percutaneous coronary intervention for left main coronary artery acute myocardial infarction and developed refractory cardiogenic shock between April 2013 and August 2021. Baseline characteristics and echocardiographic assessments were conducted 24-48 h after veno-arterial extracorporeal membrane oxygenation initiation. Patients were divided into two groups: small left ventricle (S-group, ≤ 23 mm/m<sup>2</sup> for males and ≤ 26 mm/m<sup>2</sup> for females, n = 11) and regular left ventricle (R-group, n = 22). The primary outcome was a 1-year survival. The analysis included survival and adjusted multivariate Cox proportional hazards modeling.</p><p><strong>Results: </strong>The S-group showed a significantly higher mortality rate during support (63.6% vs. 4.5%, p = 0.001). In the unadjusted survival analysis, the 1-year survival rate was significantly lower in the S-group (9.0% [95% CI, 1.4-58.9] vs. 59.1% [95% CI, 41.7-83.6], p < 0.01). After adjusting for confounders, multivariate Cox analysis identified a small left ventricle (adjusted HR 8.38, 95% CI 2.33-30.16, p = 0.001), advanced age (per 10-year increase, adjusted HR 2.35, 95% CI 1.39-3.98, p = 0.001), and lower baseline left ventricular ejection fraction (per 10% decrease, adjusted HR 0.48, 95% CI 0.26-0.88, p = 0.018) as significant predictors of 1-year all-cause mortality.</p><p><strong>Conclusions: </strong>In patients with severe cardiogenic shock following left main coronary artery acute myocardial infarction requiring veno-arterial extracorporeal membrane oxygenation, a small left ventricle is associated with a poor prognosis.</p>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.2000,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association of Left Ventricular Size on Outcomes in Patients With Left Main Coronary Artery Myocardial Infarction Complicated by Cardiogenic Shock.\",\"authors\":\"Naoki Tadokoro, Satoshi Kainuma, Kimito Minami, Satsuki Fukushima\",\"doi\":\"10.1111/aor.14974\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Cardiogenic shock in left main coronary artery acute myocardial infarction patients has high mortality rates. This study investigates the association between left ventricular size and outcomes in these patients treated with veno-arterial extracorporeal membrane oxygenation.</p><p><strong>Methods: </strong>This retrospective single-center study examined patients who underwent percutaneous coronary intervention for left main coronary artery acute myocardial infarction and developed refractory cardiogenic shock between April 2013 and August 2021. Baseline characteristics and echocardiographic assessments were conducted 24-48 h after veno-arterial extracorporeal membrane oxygenation initiation. Patients were divided into two groups: small left ventricle (S-group, ≤ 23 mm/m<sup>2</sup> for males and ≤ 26 mm/m<sup>2</sup> for females, n = 11) and regular left ventricle (R-group, n = 22). The primary outcome was a 1-year survival. The analysis included survival and adjusted multivariate Cox proportional hazards modeling.</p><p><strong>Results: </strong>The S-group showed a significantly higher mortality rate during support (63.6% vs. 4.5%, p = 0.001). In the unadjusted survival analysis, the 1-year survival rate was significantly lower in the S-group (9.0% [95% CI, 1.4-58.9] vs. 59.1% [95% CI, 41.7-83.6], p < 0.01). After adjusting for confounders, multivariate Cox analysis identified a small left ventricle (adjusted HR 8.38, 95% CI 2.33-30.16, p = 0.001), advanced age (per 10-year increase, adjusted HR 2.35, 95% CI 1.39-3.98, p = 0.001), and lower baseline left ventricular ejection fraction (per 10% decrease, adjusted HR 0.48, 95% CI 0.26-0.88, p = 0.018) as significant predictors of 1-year all-cause mortality.</p><p><strong>Conclusions: </strong>In patients with severe cardiogenic shock following left main coronary artery acute myocardial infarction requiring veno-arterial extracorporeal membrane oxygenation, a small left ventricle is associated with a poor prognosis.</p>\",\"PeriodicalId\":8450,\"journal\":{\"name\":\"Artificial organs\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2025-02-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Artificial organs\",\"FirstCategoryId\":\"5\",\"ListUrlMain\":\"https://doi.org/10.1111/aor.14974\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ENGINEERING, BIOMEDICAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Artificial organs","FirstCategoryId":"5","ListUrlMain":"https://doi.org/10.1111/aor.14974","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ENGINEERING, BIOMEDICAL","Score":null,"Total":0}
引用次数: 0
摘要
背景：左主干急性心肌梗死患者心源性休克死亡率高。本研究探讨了静脉-动脉体外膜氧合治疗患者左心室大小与预后之间的关系。方法：本回顾性单中心研究调查了2013年4月至2021年8月期间接受经皮冠状动脉介入治疗左主干急性心肌梗死并发生难治性心源性休克的患者。静脉-动脉体外膜氧合开始后24-48小时进行基线特征和超声心动图评估。将患者分为小左心室组（s组，男性≤23 mm/m2，女性≤26 mm/m2， n = 11）和正常左心室组（r组，n = 22）。主要终点为1年生存率。分析包括生存和调整多变量Cox比例风险模型。结果：s组在支持期间的死亡率显著高于s组（63.6% vs. 4.5%, p = 0.001）。在未经调整的生存分析中，s组的1年生存率显著低于s组(9.0% [95% CI, 1.4-58.9] vs. 59.1% [95% CI, 41.7-83.6]， p结论：在左主干冠状动脉急性心肌梗死后需要静脉-动脉体外膜氧合的严重心源性休克患者中，左心室小与预后不良相关。
Association of Left Ventricular Size on Outcomes in Patients With Left Main Coronary Artery Myocardial Infarction Complicated by Cardiogenic Shock.
Background: Cardiogenic shock in left main coronary artery acute myocardial infarction patients has high mortality rates. This study investigates the association between left ventricular size and outcomes in these patients treated with veno-arterial extracorporeal membrane oxygenation.
Methods: This retrospective single-center study examined patients who underwent percutaneous coronary intervention for left main coronary artery acute myocardial infarction and developed refractory cardiogenic shock between April 2013 and August 2021. Baseline characteristics and echocardiographic assessments were conducted 24-48 h after veno-arterial extracorporeal membrane oxygenation initiation. Patients were divided into two groups: small left ventricle (S-group, ≤ 23 mm/m2 for males and ≤ 26 mm/m2 for females, n = 11) and regular left ventricle (R-group, n = 22). The primary outcome was a 1-year survival. The analysis included survival and adjusted multivariate Cox proportional hazards modeling.
Results: The S-group showed a significantly higher mortality rate during support (63.6% vs. 4.5%, p = 0.001). In the unadjusted survival analysis, the 1-year survival rate was significantly lower in the S-group (9.0% [95% CI, 1.4-58.9] vs. 59.1% [95% CI, 41.7-83.6], p < 0.01). After adjusting for confounders, multivariate Cox analysis identified a small left ventricle (adjusted HR 8.38, 95% CI 2.33-30.16, p = 0.001), advanced age (per 10-year increase, adjusted HR 2.35, 95% CI 1.39-3.98, p = 0.001), and lower baseline left ventricular ejection fraction (per 10% decrease, adjusted HR 0.48, 95% CI 0.26-0.88, p = 0.018) as significant predictors of 1-year all-cause mortality.
Conclusions: In patients with severe cardiogenic shock following left main coronary artery acute myocardial infarction requiring veno-arterial extracorporeal membrane oxygenation, a small left ventricle is associated with a poor prognosis.
期刊介绍：
Artificial Organs is the official peer reviewed journal of The International Federation for Artificial Organs (Members of the Federation are: The American Society for Artificial Internal Organs, The European Society for Artificial Organs, and The Japanese Society for Artificial Organs), The International Faculty for Artificial Organs, the International Society for Rotary Blood Pumps, The International Society for Pediatric Mechanical Cardiopulmonary Support, and the Vienna International Workshop on Functional Electrical Stimulation. Artificial Organs publishes original research articles dealing with developments in artificial organs applications and treatment modalities and their clinical applications worldwide. Membership in the Societies listed above is not a prerequisite for publication. Articles are published without charge to the author except for color figures and excess page charges as noted.
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