{"id":25836,"date":"2024-06-05T04:40:00","date_gmt":"2024-06-04T20:40:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=25836"},"modified":"2024-06-05T17:04:34","modified_gmt":"2024-06-05T09:04:34","slug":"nejm%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e5%bf%83%e6%a2%97%e7%9b%b8%e5%85%b3%e5%bf%83%e6%ba%90%e6%80%a7%e4%bc%91%e5%85%8b%e7%9a%84%e5%be%ae%e8%bd%b4%e6%b5%81%e6%b3%b5%e6%88%96%e6%a0%87","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=25836","title":{"rendered":"[NEJM\u53d1\u8868\u8bba\u6587]\uff1a\u5fc3\u6897\u76f8\u5173\u5fc3\u6e90\u6027\u4f11\u514b\u7684\u5fae\u8f74\u6d41\u6cf5\u6216\u6807\u51c6\u6cbb\u7597"},"content":{"rendered":"\n

ORIGINAL ARTICLE<\/a><\/p>\n\n\n\n

Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock<\/h1>\n\n\n\n

Jacob E. M\u00f8ller, Thomas Engstr\u00f8m, Lisette O. Jensen, et al<\/h3>\n\n\n\n

N Engl J Med Published April 7, 2024<\/h3>\n\n\n\n

DOI: 10.1056\/NEJMoa2312572<\/h3>\n\n\n\n

Abstract<\/h2>\n\n\n\n

BACKGROUND<\/h3>\n\n\n\n

The effects of temporary mechanical circulatory support with a microaxial flow pump on mortality among patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock remains unclear.<\/p>\n\n\n\n

\u80cc\u666f<\/strong><\/p>\n\n\n\n

\u5728ST\u6bb5\u62ac\u9ad8\u578b\u5fc3\u808c\u6897\u6b7b\uff08STEMI\uff09\u5e76\u53d1\u5fc3\u6e90\u6027\u4f11\u514b\u7684\u60a3\u8005\u4e2d\uff0c\u4f7f\u7528\u5fae\u8f74\u6d41\u6cf5\u8fdb\u884c\u4e34\u65f6\u673a\u68b0\u5faa\u73af\u652f\u6301\u5bf9\u6b7b\u4ea1\u7387\u7684\u5f71\u54cd\u4ecd\u4e0d\u660e\u786e\u3002<\/p>\n\n\n\n

METHODS<\/h3>\n\n\n\n

In an international, multicenter, randomized trial, we assigned patients with STEMI and cardiogenic shock to receive a microaxial flow pump (Impella CP) plus standard care or standard care alone. The primary end point was death from any cause at 180 days. A composite safety end point was severe bleeding, limb ischemia, hemolysis, device failure, or worsening aortic regurgitation.<\/p>\n\n\n\n

\u65b9\u6cd5<\/strong><\/p>\n\n\n\n

\u5728\u4e00\u9879\u56fd\u9645\u591a\u4e2d\u5fc3\u968f\u673a\u8bd5\u9a8c\u4e2d\uff0c\u6211\u4eec\u5c06STEMI\u4f34\u5fc3\u6e90\u6027\u4f11\u514b\u60a3\u8005\u5206\u914d\u63a5\u53d7\u5fae\u8f74\u6d41\u6cf5\uff08Impella CP\uff09\u52a0\u6807\u51c6\u6cbb\u7597\u6216\u4ec5\u63a5\u53d7\u6807\u51c6\u6cbb\u7597\u3002\u4e3b\u8981\u7ec8\u70b9\u662f180\u5929\u5185\u5168\u56e0\u6b7b\u4ea1\u3002\u590d\u5408\u5b89\u5168\u7ec8\u70b9\u662f\u4e25\u91cd\u51fa\u8840\u3001\u80a2\u4f53\u7f3a\u8840\u3001\u6eb6\u8840\u3001\u8bbe\u5907\u6545\u969c\u6216\u4e3b\u52a8\u8109\u74e3\u53cd\u6d41\u6076\u5316\u3002<\/p>\n\n\n\n

RESULTS<\/h3>\n\n\n\n

A total of 360 patients underwent randomization, of whom 355 were included in the final analysis (179 in the microaxial-flow-pump group and 176 in the standard-care group). The median age of the patients was 67 years, and 79.2% were men. Death from any cause occurred in 82 of 179 patients (45.8%) in the microaxial-flow-pump group and in 103 of 176 patients (58.5%) in the standard-care group (hazard ratio, 0.74; 95% confidence interval [CI], 0.55 to 0.99; P=0.04). A composite safety end-point event occurred in 43 patients (24.0%) in the microaxial-flow-pump group and in 11 (6.2%) in the standard-care group (relative risk, 4.74; 95% CI, 2.36 to 9.55). Renal-replacement therapy was administered to 75 patients (41.9%) in the microaxial-flow-pump group and to 47 patients (26.7%) in the standard-care group (relative risk, 1.98; 95% CI, 1.27 to 3.09).<\/p>\n\n\n\n

\u7ed3\u679c<\/strong><\/p>\n\n\n\n

\u5171\u6709360\u540d\u60a3\u8005\u63a5\u53d7\u4e86\u968f\u673a\u5206\u7ec4\uff0c\u5176\u4e2d355\u4eba\u88ab\u7eb3\u5165\u6700\u7ec8\u5206\u6790\uff08\u5fae\u8f74\u6d41\u6cf5179\u4eba\uff0c\u6807\u51c6\u6cbb\u7597\u7ec4176\u4eba\uff09\u3002\u60a3\u8005\u7684\u4e2d\u4f4d\u5e74\u9f84\u4e3a67\u5c81\uff0c79.2%\u4e3a\u7537\u6027\u3002\u5fae\u8f74\u6d41\u6cf5179\u4f8b\u60a3\u8005\u4e2d\u670982\u4f8b\uff0845.8%\uff09\u56e0\u4efb\u4f55\u539f\u56e0\u6b7b\u4ea1\uff0c\u6807\u51c6\u6cbb\u7597\u7ec4176\u4f8b\u60a3\u8005\u4e2d\u6709103\u4f8b\uff0858.5%\uff09\u56e0\u4efb\u4f55\u539f\u56e0\u6b7b\u4ea1\uff08\u5371\u9669\u6bd4\uff0c 0.74\uff1b95% \u7f6e\u4fe1\u533a\u95f4 [CI]\uff0c0.55~0.99\uff1bP=0.04\uff09\u3002\u5fae\u8f74\u6d41\u6cf5\u670943\u540d\u60a3\u8005\uff0824.0%\uff09\u53d1\u751f\u4e86\u590d\u5408\u5b89\u5168\u7ec8\u70b9\u4e8b\u4ef6\uff0c\u6807\u51c6\u6cbb\u7597\u7ec4\u4e3a11\u540d\u60a3\u8005\uff086.2%\uff09\uff08\u76f8\u5bf9\u98ce\u9669\uff0c4.74\uff1b95% CI\uff0c2.36~9.55\uff09\u3002\u5fae\u8f74\u6d41\u6cf5\u7ec4\u548c\u6807\u51c6\u6cbb\u7597\u7ec4\u5206\u522b\u670975\u540d\u60a3\u8005\uff0841.9%\uff09\u548c47 \u540d\u60a3\u8005\uff0826.7%\uff09\u63a5\u53d7\u4e86\u80be\u810f\u66ff\u4ee3\u6cbb\u7597\uff08\u76f8\u5bf9\u98ce\u9669\uff0c1.98\uff1b95% CI\uff0c1.27~3.09\uff09\u3002<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

CONCLUSIONS<\/h3>\n\n\n\n

The routine use of a microaxial flow pump with standard care in the treatment of patients with STEMI-related cardiogenic shock led to a lower risk of death from any cause at 180 days than standard care alone. The incidence of a composite of adverse events was higher with the use of the microaxial flow pump. (Funded by the Danish Heart Foundation and Abiomed; DanGer Shock ClinicalTrials.gov number, NCT01633502<\/a>.)<\/p>\n\n\n\n

\u7ed3\u8bba<\/strong><\/p>\n\n\n\n

\u5728\u6cbb\u7597STEMI\u76f8\u5173\u5fc3\u6e90\u6027\u4f11\u514b\u60a3\u8005\u65f6\uff0c\u548c\u6807\u51c6\u6cbb\u7597\u76f8\u6bd4\uff0c\u5e38\u89c4\u4f7f\u7528\u5fae\u8f74\u6d41\u6cf5\u8054\u5408\u6807\u51c6\u6cbb\u7597\u53ef\u964d\u4f4e180\u5929\u7684\u5168\u56e0\u6b7b\u4ea1\u98ce\u9669\u3002\u4f7f\u7528\u5fae\u8f74\u6d41\u6cf5\u7684\u590d\u5408\u4e0d\u826f\u4e8b\u4ef6\u53d1\u751f\u7387\u66f4\u9ad8\u3002(\u7531\u4e39\u9ea6\u5fc3\u810f\u57fa\u91d1\u4f1a\u548cAbiomed\u8d44\u52a9\uff1bDanGer Shock\u5728ClinicalTrials.gov\u6ce8\u518c\u53f7\u4e3aNCT01633502\uff09\u3002<\/p>\n","protected":false},"excerpt":{"rendered":"

ORIGINAL ARTICLE Microaxial Flow Pump or Standard Care […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25836"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=25836"}],"version-history":[{"count":3,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25836\/revisions"}],"predecessor-version":[{"id":25843,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25836\/revisions\/25843"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=25836"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=25836"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=25836"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}