编者按：心源性休克大部分由心肌梗死引起，数据显示，6%～8%的ST段抬高型心肌梗死（STEMI）患者可发生心源性休克，是导致死亡的最主要原因。在本届美国心脏协会（AHA）科学年会上，中国医学科学院阜外医院杨跃进教授研究团队发表了题为“Cardiogenic Shock Complicating ST-Elevated Myocardial Infarction in China: Data From the China Acute Myocardial Infarction Registry”的精彩研究。现将会上展示的精彩内容，与读者共享。
陈桂浩博士在AHA现场进行壁报展示
在再灌注时代，急性心肌梗死（Acute Myocardial Infarction，AMI）并发心源性休克（Cardiogenic shock，CS）（AMICS）的院内死亡率仍较高（27%~51%）。尽管目前已有许多研究（NIS，GRACE， CUB-Réa，NCDR，CathPCI，NHDS，AMIS，NRMI）报道过AMICS，但数据都来自外国，得出的结论不能很好地反映AMICS在中国的现状。在本届AHA科学年会上，中国医学科学院阜外医院杨跃进研究团队展示的最新研究（Cardiogenic Shock Complicating ST-Elevated Myocardial Infarction in China: Data From the China Acute Myocardial Infarction Registry）旨在探讨中国ST段抬高AMI（STEMI）并发CS（STEMICS）的发病率、治疗和院内预后。
该项研究纳入2013年1月至2016年1月因STEMI在中国急性心肌梗死（CAMI）注册研究中登记的28 230例患者。结果显示，我国STEMICS的发病率为8.1%（2273），且STEMICS的发病率与医院级别的高低有明显相关性。县级医院中STEMICS的发病率明显高于市、省（13.76%、8.46%和5.23%，P<0.001）级别医院。另外，本研究中STEMICS患者行直接经皮腔内冠状动脉介入治疗（Primary percutaneous coronary intervention，PPCI ）的比例仅为29.7%，远低于欧美国家的比例（~50%）。而且，县级医院中STEMICS患者行PPCI的比例明显低于市、省级别医院（8.0%，31.5%和46.5%，P< 0.001）。
研究还发现，我国STEMICS的住院死亡率（In-hospital mortality，IHM）达49.8%；县级医院院前STEMICS的IHM明显高于市、省级别医院（42.3%、33.3% 和28.3%，P=0.0077），而院内STEMICS和总STEMICS的IHM在不同级别医院中无明显差异。
进一步分析显示，在校正PPCI后，县级医院的院前STEMICS患者的IHM与省级医院（OR=0.63，95％Cl：0.34~1.17）和市级医院（OR=0.64，95％Cl：0.38~1.08）无显著统计学差异。该研究结果提示，我国（特别是县级医院）STEMICS的现状不容乐观，需要采取更多强有力的措施（如增加PPCI的比例）以降低STEMICS的发生率和住院死亡率。
AHA 2017 杨跃进教授研究团队精彩壁报英文原文：
T2198 - Cardiogenic Shock Complicating ST-Elevated Myocardial Infarction in China: Data From the China Acute Myocardial Infarction Registry
Introduction: Cardiogenic shock (CS) remains the leading cause of death in patients with ST-Elevated Myocardial Infarction(STEMI) and no data have investigated the situation of CS complicating STEMI in China. Objective: The objective of this study is to describe the incidence， management and in-hospital mortality (IHM) of CS complicating STEMI in China and at different levels of hospitals (county-level， prefectural and provincial hospitals) .
Methods: The study population consisted of 28230 patients registered consecutively in the China Acute Myocardial Infarction (CAMI) registry from January 2013 to January 2016 who were hospitalized with an STEMI.
Results: During the years under study， 2273 patients (8.1%) developed STEMICS. The proportion of STEMI patients developing CS in provincial， prefectural and county-level hospitals were 5.23%， 8.46% and 13.76% (P < 0.001)， respectively. Primary PCI was performed on 675 patients (29.7%) with STEMICS. The proportion of STEMICS patients undertaking primary PCI in provincial， prefectural and county-level hospitals were 46.5%， 31.5% and 8.0% (P < 0.001). The overall IHM of patients with STEMICS was 49.8%. No difference was observed in the IHM of STEMICS among the different hospital levels. However， the IHM of prehospital STEMICS(STEMICS occurred before hospitalization)in county-level hospitals were significantly higher than that in prefectural and provincial hospitals (42.3% versus 33.3% and 28.3%， respectively; P<0.01)， while the IHM of in-hospital STEMICS (STEMICS developed during hospitalization)were similar among the different hospital levels (66.5%， 66.9% and 62.2%; provincial， prefectural and county-level hospitals， respectively). After adjustment， the difference of IHM in prehospital STEMICS between county-level hospitals and the other two levels no longer existed. However， once PPCI is excluded from the multivariable adjustment model， the IHM of prehospital STEMICS remained higher in county-level hospitals.
Conclusion: continuous efforts are needed to reduce the incidence and IHM of CS complicating STEMI in China， especially those who are treated in county-level hospitals.