因心脏冲击而复杂的急性心肌梗塞的Impella支持
Benedikt Schrage1, Karim Ibrahim2, Tobias Loehn2
1University Heart Centre Hamburg, Department of General and Interventional Cardiology, Germany (B.S., R.T., S.B., D.W.).
Circulation
|December 28, 2018
概括
与大动脉内气球 (IABP) 或药物治疗相比,Impella设备没有降低急性心肌梗塞与心脏冲击 (AMI- CS) 患者的30天死亡率. 在使用Impella时观察到增加的出血和血管并发症.
科学领域:
- 心脏病学
- 干预心脏病学
- 机械循环支持
背景情况:
- 通过皮肤进行的机械循环支持 (MCS) 装置越来越多地用于由心脏冲击 (AMI-CS) 复杂的急性心肌梗塞.
- 支持这些设备的有效性,如Impella,仍然有限.
- 这项研究比较了使用Impella与输入大动脉气球 (IABP) 和AMI-CS患者的治疗结果.
研究的目的:
- 评估IMPELLA设备在AMI-CS患者的使用结果.
- 在该患者群体中比较Impella对IABP和医疗治疗的有效性.
- 评估使用Impella治疗的AMI- CS患者的30天全因死亡率.
主要方法:
- 从欧洲第三级医院收集使用Impella治疗的AMI- CS患者的回顾性数据.
- 根据关键临床参数,将237名Impella患者与IABP- SHOCK II试验中的237名患者进行匹配.
- 主要终点是30天全因死亡率,并对出血和血管并发症进行二次评估.
主要成果:
- 在Impella组 (48. 5%) 和匹配的IABP组 (46. 4%) 之间,30天全因死亡率没有显著差异.
- 使用Impella与严重或危及生命的出血 (8. 5%对3. 0%) 和周围血管并发症 (9. 8%对3. 8%) 的发生率显著增加.
- 当将分析局限于IABP治疗的患者作为对照时,结果保持一致.
结论:
- 在此回顾性分析中,与IABP或药物治疗相比,Impella设备没有显示AMI- CS患者30天死亡率的降低.
- 这项研究强调使用Impella会增加出血和血管并发症的风险.
- 需要进行大型随机试验,以确定Impella设备对AMI-CS患者的结果的影响.
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