Appropriate Indications for the Use of a Percutaneous Cardiopulmonary Support System in Cases With Cardiogenic Shock Complicating Acute Myocardial Infarction

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概要

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• Percutaneous cardiopulmonary support (PCPS) is now available for hemodynamic support in patients with cardiogenic shock, but there are no guidelines for its use. The present study determined the appropriate indications for the use of the PCPS in patients with cardiogenic shock complicating acute myocardial infarction (AMI). Sixty-four consecutive patients with cardiogenic shock complicating AMI had hemodynamic support with an intraaortic balloon pump (IABP; n=38) and/or PCPS (n=26). The shock score (0-15) was calculated immediately before starting these support systems to quantify the severity of shock. Multivariate logistic regression analysis determined the clinical factors affecting in-hospital mortality. The relationship between in-hospital prognosis and the shock score was also examined in the 2 groups. The most significant factor related to the in-hospital prognosis was the shock score (p=0.0007; OR 2.16, 95%CI: 1.37-3.39). Another related factor was revascularization; however, this relationship did not reach statistical significance (p=0.069; OR 0.06). Among the 13 cases whose shock score was 4-8(moderate shock), 5 survived in the PCPS group, but only 1 of 19 patients survived in the IABP group (p<0.05). None of the patients in either group whose shock score was more than 9 survived. The severity of shock is the most reliable independent predictor of in-hospital mortality in patients with cardiogenic shock complicating AMI. Using PCPS in patients with moderate cardiogenic shock may improve their in-hospital survival, but it must be used before the shock becomes severe.

• 社団法人日本循環器学会の論文
• 2001-02-20

著者

• GOTO Yoichi

  Division of Cardiology, National Cardiovascular Center

• NONOGI Hiroshi

  Division of Cardiology, National Cardiovascular Center

• MIYAZAKI Shunichi

  Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center, Fujishiroda

• DAIKOKU Satoshi

  Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center, Fujishiroda

• MORII Isao

  Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center, Fujishiroda

• Morii Isao

  Division Of Cardiology Department Of Internal Medicine Hokusetsu General Hospital

• Daikoku Satoshi

  Division Of Cardiology Department Of Internal Medicine National Cardiovascular Center

• Nonogi Hiroshi

  Division Of Cardiology And Emergency Medicine National Cardiovascular Center

• Sasako Yoshikado

  Department Of Cardiovascular Surgery Osaka University

• Sasako Yoshikado

  Cardiovascular Surgery, National Cardiovascular Center

• ITOH Tomonori

  Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical Univer

• Sasako Yoshikado

  Department Of Cardiovascular Surgery Osaka University Graduate School Of Medicine

• Aiba Takeshi

  Division Of Cardiology Johns Hopkins University School Of Medicine

• Aiba Takeshi

  Division Of Cardiology Department Of Internal Medicine

• Nakatani Takeshi

  Research Institute, National Cardiovascular Center

• Itoh Tomonori

  Division Of Cardiology Department Of Internal Medicine Memorial Heart Center Iwate Medical Universit

• Itoh Tomonori

  Division Of Cardiology Department Of Internal Medicine National Cardiovascular Center

• Sasako Yoshikado

  The Department Of Cardiovascular Surgery National Cardiovascular Center

• Suematsu Yoshihiro

  Department of Cardiothoracic Surgery

• Miyazaki Shunichi

  Division Of Cardiology Department Of Internal Kinki University School Of Medicine

• Morii Isao

  Department Cardiology National Cardiovascular Center

• Goto Yoichi

  Division Of Cardiology Department Of Medicine National Cardiovascular Center

• Sasako Yoshikado

  The Departments Of Cardiovascular Surgery

• Nakatani Takeshi

  Organ Transplantation National Cardiovascular Center

• Nishimura Takashi

  Division Of Cardiology Department Of Internal Medicine National Cardiovascular Center

• Aiba Takeshi

  Division Of Arrhythmia And Electrophysiology Department Of Cardiology National Cerebral And Cardiova

• Nakatani Takeshi

  Division Of Cardiovascular Surgery National Cardiovascular Center

• Nonogi Hiroshi

  Division Of Cardiac Care Unit Department Of Cardiovascular Medicine National Cerebral And Cardiovasc

• Itoh Tomonori

  Division Of Cardiology Department Of Internal Medicine And Memorial Heart Center Iwate Medical Unive

• Nakatani Takeshi

  Research Division Of Agriculture Graduate School Of Kyoto Prefectural University

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