Systemic inflammatory response syndrome after acute myocardial infarction complicated by cardiogenic shock

被引:221
作者
Kohsaka, S
Menon, V
Lowe, AM
Lange, M
Dzavik, V
Steeper, LA
Hochman, JS
机构
[1] NYU, Sch Med, Cardiovasc Clin Res Ctr, New York, NY 10016 USA
[2] St Lukes Episcopal Hosp, Texas Heart Inst, Dept Cardiol, Houston, TX USA
[3] Baylor Coll Med, Houston, TX 77030 USA
[4] Univ N Carolina, Dept Cardiol, Chapel Hill, NC USA
[5] New England Res Inst, Watertown, MA USA
[6] Columbia Univ, St Lukes Roosevelt Hosp Ctr, Dept Med, New York, NY USA
[7] Univ Toronto, Div Cardiol, Toronto, ON, Canada
关键词
D O I
10.1001/archinte.165.14.1643
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: The role of inflammation in patients with coronary artery disease is emerging. We sought to assess the profile and outcomes of patients with a clinical syndrome of severe systemic inflammation that led to a diagnosis of suspected sepsis in the setting of acute myocardial infarction complicated by cardiogenic shock (CS). Methods: Patients enrolled in the randomized SHOCK (SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK) trial (n=302) were divided into those with clinical signs of severe systemic inflammation (eg, fever [94%] or leukocytosis [72%]) that led to a diagnosis of suspected sepsis (n= 54 [18%]) and those without suspected sepsis (controls; n = 243 [80%]). The patients with suspected sepsis were then further subdivided into those who were considered to be potentially infectious (positive culture result ["culture-positive"]; n=40) and those who were not (negative culture result ["culture-negative"]; n = 14). Results: Severe systemic inflammation was diagnosed 4 and 2 days after the onset of CS in culture-positive and culture-negative patients, respectively. Patients who developed systemic inflammation tended to be younger (P=.05) and to have lower systemic vascular resistance (SVR) near the onset of CS (P=.006). Many culture-positive patients (40%) had undergone coronary artery bypass graft surgery. However, the lower the initial SVR, the higher the risk of developing culture-positive systemic inflammation (P=.01), even after controlling for age and coronary artery bypass graft surgery. A time-dependent model, adjusted for age, showed that culture-positive patients were at significantly higher risk for death than were controls (hazard ratio, 2.22; 95% confidence interval, 1.32-3.76; P=.008). Conclusions: Almost one fifth of patients with acute myocardial infarction complicated by CS showed clinical signs of severe systemic inflammation, and those who were culture-positive for sepsis had twice the risk of death. The observation of lower SVR at the onset of shock in patients who subsequently had culture-positive systemic inflammation suggests that inappropriate vasodilation may play an important role in the pathogenesis and persistence of shock and in the risk of infection.
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页码:1643 / 1650
页数:8
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