急性心肌梗死心源性休克机械循环支持使用的医院间差异
结果显示23.4%患者接受IABP，12.5%接受PVAD；校正患者因素后，约13%的IABP使用差异和18%的PVAD使用差异归因于中心层面差异。高PVAD医院PCI量更高且更多为安全网机构，高PVAD医院患者升级至ECMO或LVAD的风险更低，但资源利用相似。
要点
- AMI合并心源性休克患者中，IABP使用率23.4%，PVAD使用率12.5%。
- 校正患者因素后，IABP和PVAD使用的医院间差异分别约13%和18%归因于中心层面。
- 高PVAD医院患者升级至ECMO或LVAD的风险更低，但住院时长和费用相似。
核心结论
- 急性心肌梗死合并心源性休克患者中，IABP和PVAD的使用存在广泛的医院间差异。
- 高PVAD医院患者升级至ECMO或LVAD的风险更低，但资源利用相似。
研究设计与样本
- 患者分为IABP、PVAD和无机械循环支持三组，主要目标是量化医院间使用IABP和PVAD的差异。
主要发现
- 23.4%患者接受IABP，12.5%接受PVAD。
- 校正患者因素后，约13%（11-14%）的IABP使用差异和18%（15-20%）的PVAD使用差异归因于中心层面差异。
- 高PVAD医院年PCI量更高（257例/年 vs 204例/年，p=0.032），且更常见为安全网机构（27.4% vs 11.3%，p=0.023）。
- 高PVAD医院患者升级至ECMO的风险更低（0.52，95% CI 0.29-0.95），升级至LVAD的风险也更低（0.28，95% CI 0.08-0.94）。
临床怎么用
- 临床实践中需认识到IABP和PVAD的使用存在医院间差异，缺乏标准化算法。
- 高PVAD医院可能更倾向于使用PVAD，并与较低的ECMO或LVAD升级风险相关，但资源利用无差异。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
BACKGROUND: Cardiogenic shock (CS) is a leading cause of mortality following acute myocardial infarction (AMI). Some patients may require intra-aortic balloon pump (IABP) or percutaneous ventricular assist device (PVAD) placement; however, there is a paucity of standardised algorithms to guide the deployment of each device. The present study evaluated interhospital variation in the use of IABP and PVAD for AMI CS and identified institutional factors associated with hospital-level device preference. METHODS: All non-elective adult hospitalisations entailing AMI and CS were identified within the 2019 Nationwide Readmissions Database. Patients were grouped into IABP, PVAD and non-mechanical circulatory support cohorts. The primary aim was to quantify the degree of interhospital variation in the use of IABP and PVAD. Escalation to extracorporeal membrane oxygenation (ECMO), left ventricular assist device (LVAD) implantation, length of stay and hospitalisation costs were secondarily assessed. Hospital factors, such as percutaneous coronary intervention (PCI) volume and safety net status, were also analysed. RESULTS: Among 53 903 patients, 23.4% received IABP, and 12.5% received PVAD. After adjustment for patient factors, approximately 13% (11-14%) of variation in IABP use and 18% (15-20%) of PVAD use were attributable to centre-level differences. High-PVAD hospitals had higher annual PCI volume (257 (185-369) vs 204 (148-276) cases/year, p=0.032) and were more commonly safety net institutions (27.4% vs 11.3%, p=0.023), compared to high-IABP hospitals. Patients treated at high-IABP and high-PVAD hospitals faced similar length of stay (β -0.16, 95% CI -1.82 to 1.49) and costs (β -$3500, 95% CI -16 600 to 9600). Those at high-PVAD hospitals had lower adjusted risk of escalation to ECMO (0.52, 95% CI 0.29 to 0.95) and LVAD implantation (0.28, 95% CI 0.08 to 0.94). CONCLUSIONS: The present study identified wide interhospital variation in the use of IABP and PVAD for AMI CS. Although the likelihood of escalation to ECMO or LVAD differed between hospital types, resource utilisation was similar.
引用
- Verma, Chervu, Kim, et al. Variation in mechanical circulatory support use for acute myocardial infarction cardiogenic shock. Heart. 2026. PMID: 40850742. doi:10.1136/heartjnl-2024-325413
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。