JAMA Intern Med:PCI策略与急性心肌梗死和心源性休克患者不良预后

2020-08-25 MedSci原创 MedSci原创

近年来急性心肌梗死和心源性休克患者接受多血管经皮冠状动脉介入治疗的比例逐年增加,但相比于主要梗死血管PCI,多血管PCI后患者的不良预后率也显著增加

急性心肌梗死(AMI)和心源性休克患者的死亡率较高,特别是存在多血管冠状动脉疾病的患者中。近日研究人员比较了多血管经皮冠状动脉介入治疗(Multivessel -PCI)或主要梗死血管PCI(culprit-vessel PCI)对患者预后的影响。
 
 
研究人员收集了2009-18年间,美国AMI及心源性休克患者PCI数据,研究的主要结果是院内死亡率,同时评估PCI策略的时间变化趋势和院间差异,次要终点为PCI策略与患者预后。
 
64301名患者参与研究,平均年龄66.4岁,女性占31.7%,其中34.9%的患者接受了多血管PCI,在48943例ST段抬高性心肌梗死(STEMI)亚组患者中,31.5%的患者接受了多血管PCI。2009-18年间,AMI患者多血管PCI率年均增加6.7%,STEMI多血管PCI率年均增加5.8%。
总体而言,多血管PCI与患者院内并发症风险(OR=1.18)以及STEMI患者院内死亡率(1.11)增加相关。对于医保参保人,多血管PCI不增加1年内院外死亡率(51.5% vs 49.8%,OR=0.97)。
 
不同医疗机构间,多血管PCI率差异显著,特别值得关注的是,STEMI患者PCI实施率较高的医院,患者接受多血管PCI后院内死亡率也较高(最高1/4 vs 最低1/4,OR=1.10)。
 
近年来急性心肌梗死和心源性休克患者接受多血管经皮冠状动脉介入治疗的比例逐年增加,但相比于主要梗死血管PCI,多血管PCI后患者的不良预后率也显著增加。
 
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    2020-08-27 14818eb4m67暂无昵称

    学习了

    0

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    2020-08-27 ms7000000689223974

    很好很详细,谢谢分享

    0

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  5. [GetPortalCommentsPageByObjectIdResponse(id=814068, encodeId=4c8081406827, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=64245268311, createdName=14818eb4m67暂无昵称, createdTime=Thu Aug 27 14:34:37 CST 2020, time=2020-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=813914, encodeId=6d24813914f6, content=很好很详细,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200823/ece0a24ea5824924b9ba0b87a5947f86/11f20d29045c49fd9671ef69fa0c4012.jpg, createdBy=f64a5412720, createdName=ms7000000689223974, createdTime=Thu Aug 27 10:05:41 CST 2020, time=2020-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1332166, encodeId=472e13321664c, content=<a href='/topic/show?id=88f9510800b' target=_blank style='color:#2F92EE;'>#心源性休克#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51080, encryptionId=88f9510800b, topicName=心源性休克)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e3fb2500073, createdName=124987cdm26暂无昵称, createdTime=Thu Aug 27 09:49:42 CST 2020, time=2020-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1336421, encodeId=5bb51336421e1, content=<a href='/topic/show?id=071820530c5' target=_blank style='color:#2F92EE;'>#不良预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20530, encryptionId=071820530c5, topicName=不良预后)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c97a2500111, createdName=thinkibmz_44722594, createdTime=Thu Aug 27 09:49:42 CST 2020, time=2020-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1593526, encodeId=a33b1593526bd, content=<a href='/topic/show?id=9850510e9a3' target=_blank style='color:#2F92EE;'>#心源性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51079, encryptionId=9850510e9a3, topicName=心源性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=955718147815, createdName=mhm295, createdTime=Thu Aug 27 09:49:42 CST 2020, time=2020-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1610674, encodeId=14a716106e413, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Thu Aug 27 09:49:42 CST 2020, time=2020-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=813351, encodeId=271181335118, content=很详细,很有用,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200823/ece0a24ea5824924b9ba0b87a5947f86/11f20d29045c49fd9671ef69fa0c4012.jpg, createdBy=f64a5412720, createdName=ms7000000689223974, createdTime=Wed Aug 26 09:16:57 CST 2020, time=2020-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036236, encodeId=81fe1036236be, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Tue Aug 25 21:49:42 CST 2020, time=2020-08-25, status=1, ipAttribution=)]
    2020-08-27 mhm295
  6. [GetPortalCommentsPageByObjectIdResponse(id=814068, encodeId=4c8081406827, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=64245268311, createdName=14818eb4m67暂无昵称, createdTime=Thu Aug 27 14:34:37 CST 2020, time=2020-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=813914, encodeId=6d24813914f6, content=很好很详细,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200823/ece0a24ea5824924b9ba0b87a5947f86/11f20d29045c49fd9671ef69fa0c4012.jpg, createdBy=f64a5412720, createdName=ms7000000689223974, createdTime=Thu Aug 27 10:05:41 CST 2020, time=2020-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1332166, encodeId=472e13321664c, content=<a href='/topic/show?id=88f9510800b' target=_blank style='color:#2F92EE;'>#心源性休克#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51080, encryptionId=88f9510800b, topicName=心源性休克)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e3fb2500073, createdName=124987cdm26暂无昵称, createdTime=Thu Aug 27 09:49:42 CST 2020, time=2020-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1336421, encodeId=5bb51336421e1, content=<a href='/topic/show?id=071820530c5' target=_blank style='color:#2F92EE;'>#不良预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20530, encryptionId=071820530c5, topicName=不良预后)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c97a2500111, createdName=thinkibmz_44722594, createdTime=Thu Aug 27 09:49:42 CST 2020, time=2020-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1593526, encodeId=a33b1593526bd, content=<a href='/topic/show?id=9850510e9a3' target=_blank style='color:#2F92EE;'>#心源性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51079, encryptionId=9850510e9a3, topicName=心源性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=955718147815, createdName=mhm295, createdTime=Thu Aug 27 09:49:42 CST 2020, time=2020-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1610674, encodeId=14a716106e413, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Thu Aug 27 09:49:42 CST 2020, time=2020-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=813351, encodeId=271181335118, content=很详细,很有用,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200823/ece0a24ea5824924b9ba0b87a5947f86/11f20d29045c49fd9671ef69fa0c4012.jpg, createdBy=f64a5412720, createdName=ms7000000689223974, createdTime=Wed Aug 26 09:16:57 CST 2020, time=2020-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036236, encodeId=81fe1036236be, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Tue Aug 25 21:49:42 CST 2020, time=2020-08-25, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=814068, encodeId=4c8081406827, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=64245268311, createdName=14818eb4m67暂无昵称, createdTime=Thu Aug 27 14:34:37 CST 2020, time=2020-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=813914, encodeId=6d24813914f6, content=很好很详细,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200823/ece0a24ea5824924b9ba0b87a5947f86/11f20d29045c49fd9671ef69fa0c4012.jpg, createdBy=f64a5412720, createdName=ms7000000689223974, createdTime=Thu Aug 27 10:05:41 CST 2020, time=2020-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1332166, encodeId=472e13321664c, content=<a href='/topic/show?id=88f9510800b' target=_blank style='color:#2F92EE;'>#心源性休克#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51080, encryptionId=88f9510800b, topicName=心源性休克)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e3fb2500073, createdName=124987cdm26暂无昵称, createdTime=Thu Aug 27 09:49:42 CST 2020, time=2020-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1336421, encodeId=5bb51336421e1, content=<a href='/topic/show?id=071820530c5' target=_blank style='color:#2F92EE;'>#不良预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20530, encryptionId=071820530c5, topicName=不良预后)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c97a2500111, createdName=thinkibmz_44722594, createdTime=Thu Aug 27 09:49:42 CST 2020, time=2020-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1593526, encodeId=a33b1593526bd, content=<a href='/topic/show?id=9850510e9a3' target=_blank style='color:#2F92EE;'>#心源性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51079, encryptionId=9850510e9a3, topicName=心源性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=955718147815, createdName=mhm295, createdTime=Thu Aug 27 09:49:42 CST 2020, time=2020-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1610674, encodeId=14a716106e413, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Thu Aug 27 09:49:42 CST 2020, time=2020-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=813351, encodeId=271181335118, content=很详细,很有用,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200823/ece0a24ea5824924b9ba0b87a5947f86/11f20d29045c49fd9671ef69fa0c4012.jpg, createdBy=f64a5412720, createdName=ms7000000689223974, createdTime=Wed Aug 26 09:16:57 CST 2020, time=2020-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036236, encodeId=81fe1036236be, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Tue Aug 25 21:49:42 CST 2020, time=2020-08-25, status=1, ipAttribution=)]
    2020-08-26 ms7000000689223974

    很详细,很有用,谢谢分享

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=814068, encodeId=4c8081406827, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=64245268311, createdName=14818eb4m67暂无昵称, createdTime=Thu Aug 27 14:34:37 CST 2020, time=2020-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=813914, encodeId=6d24813914f6, content=很好很详细,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200823/ece0a24ea5824924b9ba0b87a5947f86/11f20d29045c49fd9671ef69fa0c4012.jpg, createdBy=f64a5412720, createdName=ms7000000689223974, createdTime=Thu Aug 27 10:05:41 CST 2020, time=2020-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1332166, encodeId=472e13321664c, content=<a href='/topic/show?id=88f9510800b' target=_blank style='color:#2F92EE;'>#心源性休克#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51080, encryptionId=88f9510800b, topicName=心源性休克)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e3fb2500073, createdName=124987cdm26暂无昵称, createdTime=Thu Aug 27 09:49:42 CST 2020, time=2020-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1336421, encodeId=5bb51336421e1, content=<a href='/topic/show?id=071820530c5' target=_blank style='color:#2F92EE;'>#不良预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20530, encryptionId=071820530c5, topicName=不良预后)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c97a2500111, createdName=thinkibmz_44722594, createdTime=Thu Aug 27 09:49:42 CST 2020, time=2020-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1593526, encodeId=a33b1593526bd, content=<a href='/topic/show?id=9850510e9a3' target=_blank style='color:#2F92EE;'>#心源性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51079, encryptionId=9850510e9a3, topicName=心源性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=955718147815, createdName=mhm295, createdTime=Thu Aug 27 09:49:42 CST 2020, time=2020-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1610674, encodeId=14a716106e413, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Thu Aug 27 09:49:42 CST 2020, time=2020-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=813351, encodeId=271181335118, content=很详细,很有用,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200823/ece0a24ea5824924b9ba0b87a5947f86/11f20d29045c49fd9671ef69fa0c4012.jpg, createdBy=f64a5412720, createdName=ms7000000689223974, createdTime=Wed Aug 26 09:16:57 CST 2020, time=2020-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036236, encodeId=81fe1036236be, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Tue Aug 25 21:49:42 CST 2020, time=2020-08-25, status=1, ipAttribution=)]
    2020-08-25 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

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