梗死相关心源性休克合并多支血管病变时冠状动脉疾病的复杂性：DanGer Shock试验的一项子研究。
完整摘要 · 中文译文
背景：梗死相关心源性休克（CS）中多支冠状动脉病变解剖及复杂程度的预后影响尚未充分明确。 目的：我们旨在探讨基线及残余SYNTAX评分在多支病变（MVD）及梗死相关CS中的预后价值，以及它们对微轴流泵（mAFP）支持效果的影响。 方法：在这项DanGer Shock试验的二次分析中，MVD定义为≥1处非罪犯狭窄≥70%或孤立性左主干（LM）罪犯病变。基线SYNTAX评分分为低（≤22）、中（23-32）或高（>32）。孤立性LM罪犯病变患者单独分析。主要结局为180天全因死亡率。 结果：在DanGer Shock纳入的355例患者中，256例患有MVD；211例有可用的基线SYNTAX评分，其中26%位于低基线SYNTAX组，47%位于中基线SYNTAX组，27%位于高基线SYNTAX组。共有35例患者为孤立性LM罪犯病变。与低和中基线SYNTAX评分相比，高基线SYNTAX评分与更高的180天全因死亡率几率相关（校正比值比[OR] 3.12，95%置信区间[CI]：1.17-8.69）。较高的基线SYNTAX评分与较高的残余SYNTAX评分相关（p<0.001）。残余SYNTAX评分独立预测180天全因死亡率。mAFP效果未被基线SYNTAX组别所修饰（交互作用p=0.31）。在孤立性LM罪犯病变患者中，使用mAFP与较低的180天全因死亡率几率相关 与单纯标准治疗相比，全因死亡率（校正OR 0.17，95% CI：0.03-0.99）。 结论：基线和残余SYNTAX评分独立预测180天死亡率。mAFP效应未受SYNTAX指标影响。在孤立左主干亚组中，观察到使用mAFP可能带来临床获益的假设生成性信号。
完整摘要 · 英文原文
BACKGROUND: The prognostic impact of multivessel coronary anatomy and complexity in infarct-related cardiogenic shock (CS) is insufficiently characterised. AIMS: We sought to investigate the prognostic value of baseline and residual SYNTAX scores and their influence on the effect of microaxial flow pump (mAFP) support in multivessel disease (MVD) and infarct-related CS. METHODS: In this secondary analysis of the DanGer Shock trial, MVD was defined as ≥1 non-culprit stenosis ≥70% or an isolated left main (LM) culprit lesion. Baseline SYNTAX scores were categorised as low (≤22), intermediate (23-32), or high (>32). Patients with an isolated LM culprit lesion were analysed separately. The primary outcome was 180-day all-cause mortality. RESULTS: Of 355 patients included in DanGer Shock, 256 patients had MVD; 211 had an available baseline SYNTAX score, with 26% of these in the low, 47% in the intermediate, and 27% in the high baseline SYNTAX groups. In all, 35 patients had an isolated LM culprit lesion. A high baseline SYNTAX score was associated with higher odds of 180-day all-cause mortality compared with low and intermediate baseline SYNTAX scores (adjusted odds ratio [OR] 3.12, 95% confidence interval [CI]: 1.17-8.69). A higher baseline SYNTAX score was associated with a higher residual SYNTAX score (p<0.001). The residual SYNTAX score independently predicted 180-day all-cause mortality. The mAFP effect was not modified by the baseline SYNTAX group (p for interaction=0.31). In patients with an isolated LM culprit lesion, mAFP use was associated with lower odds of 180-day all-cause mortality compared with standard care alone (adjusted OR 0.17, 95% CI: 0.03-0.99). CONCLUSIONS: Baseline and residual SYNTAX scores independently predicted 180-day mortality. The mAFP effect was not modified by SYNTAX measures. In the isolated left main subgroup, a hypothesis-generating signal towards a clinical benefit with mAFP use was observed.