Читать книгу Interventional Cardiology - Группа авторов - Страница 336

Cardiogenic shock after myocardial infarction (MI) occurs in about 5–6% of cases in the current era of primary PCI, and occurred in about 10% of cases in the era before rapid mechanical reperfusion [6–10]. The incidence of cardiogenic shock may have declined, but mortality after cardiogenic shock remains very high, even in contemporary cohorts, with mortality rates of 40–60% [11, 12].

An early study of 845 patients presenting with acute MI not treated with thrombolysis or mechanical reperfusion investigated risk factors for the occurrence of cardiogenic shock [6]. In this study, cardiogenic shock occurred in 60 patients (7.1%). Predictors of cardiogenic shock included age >65 years, left ventricular ejection fraction at hospital admission <35%, large infarct size (peak creatine kinase‐MB isoenzyme >160 IU/liter), diabetes mellitus, and previous myocardial infarction. Risk factors in the GUSTO (Global utilization of streptokinase and tissue‐plasminogen activator for occluded coronary arteries) trial, conducted in the era of thrombolysis included: age, systolic blood pressure, heart rate, and Killip class upon presentation [13].

In the large (n = 5745) APEX‐AMI (assessment of pexelizumab in acute myocardial infarction) trial, the incidence of shock was only 3.4% (n = 196), most likely due to the fact that this randomized controlled trial enrolled a relatively low‐risk patient population [12]. In APEX‐AMI the following risk factors for developing cardiogenic shock were identified: older age, female sex, hypertension, diabetes mellitus, and being a non‐smoker.