Особенности лечения кардиогенного шока у пациентов с острым коронарным синдромом по данным Федерального регистра
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Sagaydak O.V., Oschepkova E.V., Chazova I.E. Cardiogenic shock in patients with acute coronary syndrome (data from Russian Federal Acute Coronary Syndrome Registry). Therapeutic Archive. 2019; 91 (9): 47–52. DOI: 10.26442/00403660.2019.09.000317
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Цель работы. Оценить качество медицинской помощи больным с ОКС, осложнившимся КШ, и ее соответствие современным клиническим рекомендациям.
Материалы и методы. Данные пациентов с ОКС экспортированы из системы федерального регистра ОКС. В исследовании проанализированы данные 29 736 пациентов с ОКС, внесенные в систему за период с 01.01.2018 по 31.12.2018 г. Из 29 736 пациентов с ОКС у 824 пациентов с ОКС был диагностирован КШ. Для оценки качества оказания медицинской помощи пациентам с ОКС и КШ использованы основные клинические рекомендации по лечению данной патологии.
Результаты. Проанализирована группа из 824 пациентов с ОКС и КШ, в которой преобладали больные с ОКС с подъемом сегмента ST (ОКСпST) – 77,8% (n=641). По данным регистра ОКС, 44,3% (n=365) пациентов с ОКС и КШ получали консервативное лечение, из них 58,6% (n=108) были с ОКСпST. Чрескожное коронарное вмешательство (ЧКВ) проведено у 39% (n=321) пациентов, из них 89,4% (n=271) пациенты с ОКСпST. По данным настоящего исследования, тромболитическая терапия проведена у 26,5% (n=218) пациентов.
Заключение. Полученные данные продемонстрировали, что пациенты c ОКС и КШ не получают оптимальную медицинскую помощь и их лечение не соответствует в полной мере современным клиническим рекомендациям.
Ключевые слова: ишемическая болезнь сердца, острый коронарный синдром, кардиогенный шок, смертность, острый инфаркт миокарда.
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Mortality in acute coronary syndrome (ACS) and its complications remains high, despite significant advances in the treatment of coronary heart disease and its complications. One of the most life-threatening complications of ACS is cardiogenic shock (CS). CS is an extreme degree of acute heart failure and develops on average in 5–8% of patients hospitalized with ACS. In the present work, we analyzed data from Russian Federal ACS Registry – frequency of CS occurrence, treatment methods, and outcomes of ACS complicated by CS.
Aim. Assess the quality of medical care in patients with ACS, which complicated by CS, and its compliance with current clinical guidelines.
Materials and methods. Data from patients with ACS were exported from the Russian Federal ACS Registry. The study analyzed the data of 29.736 patients with ACS entered into the registry system in the period from 01.01.2018 to 31.12.2018. Of the 29.736 patients with ACS, 824 patients were diagnosed with CS. To assess the quality of care provided to patients with ACS and CS, the main clinical gguidelines were used.
Results. The group of 824 patients with ACS and CS was analyzed. Among them patients with ACS with ST segment elevation prevailed – 77.8% (n=641). According to Russian Federal ACS Registry 44.3% (n=365) of patients with ACS and CS received conservative treatment, of which 58.6% (n=108) were with ACS with ST segment elevation. Percutaneous coronary intervention was performed in 39% (n=321) of patients, of whom 89.4% (n=271) of patients with ACS with ST segment elevation. According to the data of this study, thrombolytic therapy was performed in 26.5% (n=218) of patients.
Conclusion. The data obtained demonstrated that patients with ACS and CS did not receive optimal medical care and their treatment does not fully comply with modern clinical guidelines.
Keywords: coronary heart disease, acute coronary syndrome, cardiogenic shock, mortality, acute myocardial infarction.
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3. Babaev A, Frederick PD, Pasta DJ, et al. Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. JAMA. 2005;294:448-54. doi: 10.1001/jama.294.4.448
4. Goldberg RJ, Samad NA, Yarzebski J, et al. Temporal trends in cardio- genic shock complicating acute myocardial infarction. N Engl J Med. 1999;340:1162-8. doi: 10.1056/NEJM199904153401504
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23. Shaefi S, O’Gara B, Kociol RD, Joynt K, Mueller A, Nizamuddin J, Mahmood E, Talmor D, Shahul S. Effect of cardiogenic shock hospital volume on mortality in patients with cardiogenic shock. J Am Heart Assoc. 2015;4:e001462. doi: 10.1161/JAHA.114.001462
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25. Kolte D, Khera S, Aronow WS, Mujib M, Palaniswamy C, Sule S, Jain D, Gotsis W, Ahmed A, Frishman WH, Fonarow GC. Trends in incidence, management, and outcomes of cardiogenic shock complicating ST-elevation myocardial infarction in the United States. J Am Heart Assoc. 2014;3:e000590. doi: 10.1161/JAHA.113.000590
26. Harjola VP, Lassus J, Sionis A, Køber L, Tarvasmäki T, Spinar J, Parissis J, Banaszewski M, Silva-Cardoso J, Carubelli V, Di Somma S, Tolppanen H, Zeymer U, Thiele H, Nieminen MS, Mebazaa A. CardShock Study Investigators; GREAT Network. Clinical picture and risk prediction of short-term mortality in cardiogenic shock (published correction appears in Eur J Heart Fail. 2015; 17:984) Eur J Heart Fail. 2015;17:501-9. doi: 10.1002/ejh f.260
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28. Vaitkus PT, Witmer WT, Brandenburg RG, Wells SK, Zenhnacker JB. Economic Impact of Angioplasty Salvage Techniques, With an Emphasis on Coronary Stents: A Method Incorporating Costs, Revenues, Clinical Effectiveness and Payer Mix. J Am Coll Cardiol. 1997; 30:894-900. doi: 10.1 016/S0735-1097(97)00251-9
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1. [Giliarevsky SR, Rezvan VV, Kuzmina IM, Lopotovsky PY. Management tactics for patients with cardiogenic shock due to acute myocardial infarction: evidence base, and actual practice. Russian Sklifosovsky Journal "Emergency Medical Care". 2014;(1):38-44 (In Russ.)].
2. Reynolds HR, Hochman JS. Cardiogenic shock: current concepts and improving outcomes. Circulation. 2008;117:686-97. doi: 10.1161/circulation aha.106.613596
3. Babaev A, Frederick PD, Pasta DJ, et al. Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. JAMA. 2005;294:448-54. doi: 10.1001/jama.294.4.448
4. Goldberg RJ, Samad NA, Yarzebski J, et al. Temporal trends in cardio- genic shock complicating acute myocardial infarction. N Engl J Med. 1999;340:1162-8. doi: 10.1056/NEJM199904153401504
5. Holmes DRJr, Bates ER, Kleiman NS, et al. Contemporary reperfusion therapy for cardiogenic shock: the GUSTO-I trial experience. The GUSTO-I Investigators. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries. J Am Coll Cardiol. 1995;26:668-74. doi: 10.1016/0735-1097(95)00215-P
6. Holmes DRJr, Berger PB, Hochman JS, et al. Cardiogenic shock in patients with acute ischemic syndromes with and without ST-segment elevation. Circulation. 1999;100:2067-73. doi: 10.1161/01.CIR.100.20.2067
7. Jeger RV, Radovanovic D, Hunziker PR, et al. Ten-year trends in the incidence and treatment of cardiogenic shock. Ann Intern Med. 2008;149:618-26. doi: 10.7326/0003-4819-149-9-200811040-00005
8. Hochman JS, Sleeper LA, Webb JG, et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med. 1999;341:625-34. doi: 10.1056/NEJM19 9908263410901
9. Webb JG, Sleeper LA, Buller CE, et al. Implications of the timing of onset of cardiogenic shock after acute myocardial infarction: a report from the SHOCK Trial Registry. Should we emergently revascularize Occluded Coronaries for cardiogenic shock? J Am Coll Cardiol. 2000;36:1084-90. doi: 10.1016/S0735-1097(00)00876-7
10. Goldberg RJ, Spencer FA, Gore JM, et al. Thirty-year trends (1975 to 2005) in the magnitude of, management of, and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: a population-based perspective. Circulation. 2009;119:1211-9. doi: 10.1161/circulation aha.108.814947
11. Hochman JS, Sleeper LA, White HD, et al. One-year survival following early revascularization for cardiogenic shock. JAMA. 2001;285:190-2. doi: 10.1001/jama.285.2.190
12. Kohsaka S, Menon V, Lowe AM, et al. Systemic inflammatory response syndrome after acute myocardial infarction complicated by cardiogenic shock. Arch Intern Med. 2005;165:1643-50. doi: 10.1001/archinte.165.14. 1643
13. [Dovgalevsky P, Gridnev V, Oshchepkova E, et al. Federal Registry of Acute Coronary Syndrome user guide. Cardio-IT. 2014;1(2):0203 (In Russ.)]. doi: 10.15275/cardioit.2014.0203
14. Manesh R Patel, Gregory J Dehmer, John W Hirshfeld, Peter K Smith, John A Spertus. ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 Appropriate Use Criteria for Coronary Revascularization Focused Update. J Amer College of Cardiology. 2012;59(9):857-81; doi: 10.1016/j.jacc.2011. 12.001
15. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-77. doi: 10.1093/eurheartj/ehx393
16. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, Bax JJ, Borger MA, Brotons C, Chew DP, Gencer B, Hasenfuss G, Kjeldsen K, Lancellotti P, Landmesser U, Mehilli J, Mukherjee D, Storey RF, Windecker S. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(3):267-315. doi: 10.1093/eurheartj/ ehv320
17. Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014;35(37):2541-619. doi: 10.1093/eurheartj/ehu278
18.[Ruda MYa, Averkov OV, Panchenko EP, Yavelov IS. Recommendations of the Society of Specialists in Urgent Cardiology. Diagnosis and Treatment of Patients With Non-ST-Segment Elevation Acute Coronary Syndrome. Part 1. Kardiologiya. 2017;57(8):80-100 (In Russ.)]. doi: 10.18087/cardio.2017.8.10023
19. Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: a report of the American College of Cardiology Foundation. American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation. 2011;124(23):e574-651. doi: 10.1161/CIR.0b013e31823ba622
20. Manesh R. Patel, Gregory J. Dehmer, John W. Hirshfeld, Peter K. Smith, John A. Spertus. ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 Appropriate Use Criteria for Coronary Revascularization Focused Update. J Amer College of Cardiology. 2012;59(9):857-81. doi: 10.1016/j.jacc.2011.1 2.001
21. [Sagaydak OV, Oschepkova EV, Popova YV, Kiselev AR, Konosova ID, Gridnev VI. Approaches to optimization of acute coronary syndrome patients care timing characteristic in federal acute coronary syndrome registry system and Russian Ministry of health monitoring system. Kardiologicheskiy vestnik. 2017;15(4):96-101 (In Russ.)].
22. Van Diepen S, Katz JN, Albert NM, et al. On behalf of the American Heart Association Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research; and Mission: Lifeline. Contemporary Management of Cardiogenic Shock: A Scientific Statement from the American Heart Association. Circulation. 2017; Sep 18 [Epub ahead of print]. doi: 10.1161/CIR.0000000000000525
23. Shaefi S, O’Gara B, Kociol RD, Joynt K, Mueller A, Nizamuddin J, Mahmood E, Talmor D, Shahul S. Effect of cardiogenic shock hospital volume on mortality in patients with cardiogenic shock. J Am Heart Assoc. 2015;4:e001462. doi: 10.1161/JAHA.114.001462
24. Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Fuhrmann J, Böhm M, Ebelt H, Schneider S, Schuler G, Werdan K. IABP-SHOCK II Trial Investigators. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med. 2012;367:1287-96. doi: 10.1056/NEJMoa1208410
25. Kolte D, Khera S, Aronow WS, Mujib M, Palaniswamy C, Sule S, Jain D, Gotsis W, Ahmed A, Frishman WH, Fonarow GC. Trends in incidence, management, and outcomes of cardiogenic shock complicating ST-elevation myocardial infarction in the United States. J Am Heart Assoc. 2014;3:e000590. doi: 10.1161/JAHA.113.000590
26. Harjola VP, Lassus J, Sionis A, Køber L, Tarvasmäki T, Spinar J, Parissis J, Banaszewski M, Silva-Cardoso J, Carubelli V, Di Somma S, Tolppanen H, Zeymer U, Thiele H, Nieminen MS, Mebazaa A. CardShock Study Investigators; GREAT Network. Clinical picture and risk prediction of short-term mortality in cardiogenic shock (published correction appears in Eur J Heart Fail. 2015; 17:984) Eur J Heart Fail. 2015;17:501-9. doi: 10.1002/ejh f.260
27. [Martynchik SA, Filatenkova SV. Medical and economic evaluation and substantiation of the technologies and programs for budgeting of inpatient care in ischemic heart disease: brief literature review. Social'nye aspekty zdorov'a naselenia = Social aspects of population health [serial online] (In Russ.)]. Доступно по ссылке (ссылка активна на 28.01.2019): http://vestnik. mednet.ru/ content/view/395/30/lang,ru/
28. Vaitkus PT, Witmer WT, Brandenburg RG, Wells SK, Zenhnacker JB. Economic Impact of Angioplasty Salvage Techniques, With an Emphasis on Coronary Stents: A Method Incorporating Costs, Revenues, Clinical Effectiveness and Payer Mix. J Am Coll Cardiol. 1997; 30:894-900. doi: 10.1 016/S0735-1097(97)00251-9
Научно-исследовательский институт клинической кардиологии им. А.Л. Мясникова ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия
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O.V. Sagaydak, E.V. Oschepkova, I.E. Chazova
Myasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Moscow, Russia