血运重建前 IABP 对 ACS 合并心源性休克患者死亡率的影响
血运重建前主动脉内球囊反搏对急性冠脉综合征合并心源性休克患者死亡率的影响
据报道,急性冠脉综合征患者心源性休克的患病率约为 5-8%,死亡率很高。 血运重建方法已被称为标准治疗,但主动脉内球囊泵(IABP)作为机械循环支持的使用仍存在争议。 IABP SHOCK II 试验显示,IABP 并未改善短期死亡率,但研究中未考虑几个与死亡率相关的基本变量,即 IABP 启动时间和撤机方案。本研究旨在评估 IABP 之前的影响血运重建对心肌梗死合并休克患者死亡率的影响。
92 名受试者将被纳入这项随机对照试验,分为两组,有和没有 IABP。 IABP 组将在血运重建前接受干预。 需要寻求的主要结果是血运重建后的院内死亡率和 30 天死亡率。 IABP 效果通过第 1 和 3 天超声心动图的全球纵向应变、第 1、3 和 5 天的 NTproBNP 和 ST2 水平、第 1 和 3 天的有效乳酸清除率和尿素肌酐水平等各种指标测量,并将进行比较两组之间。 连续变量将以均值±偏差标准或中位数呈现,并酌情使用学生 t 检验或 Mann-Whitney U 检验进行分析。
研究概览
研究类型
注册 (实际的)
阶段
- 不适用
联系人和位置
学习地点
-
-
-
Jakarta、印度尼西亚、11420
- National Cradiovascular Center Harapan Kita Hospital
-
-
参与标准
资格标准
适合学习的年龄
接受健康志愿者
描述
纳入标准:
- 年龄大于18岁
- 心肌梗死合并休克患者
- 愿意参加研究(签署同意书)
排除标准:
- 年龄大于80岁
- 心肺复苏30多分钟
- 心源性休克发作 >12 小时(如果知道)或 >18 小时(如果不知道/在急诊室就诊的患者已经出现休克)
- 心肌梗死的机械性并发症
- 中度和重度主动脉瓣反流
- 外周动脉疾病使 IABP 不可行
- 未接受经皮冠状动脉介入治疗血运重建的患者
- 在 IABP 插入前死亡的患者
- 家人要求终止护理
学习计划
研究是如何设计的?
设计细节
- 主要用途:治疗
- 分配:随机化
- 介入模型:并行分配
- 屏蔽:无(打开标签)
武器和干预
参与者组/臂 |
干预/治疗 |
|---|---|
|
无干预:控制
未接受 IABP 的患者组
|
|
|
实验性的:主动脉内球囊泵
在血运重建前接受主动脉内球囊反搏的患者组
|
主动脉内球囊泵 (IABP) 是一种循环机械支持装置,放置在降主动脉中,远离左锁骨下动脉,靠近肾动脉。 IABP 采用反搏概念,与心脏周期同步。 它适用于接受血运重建、心源性休克和机械并发症的患者的支持疗法。 舒张期球囊扩张增加主动脉舒张压,改善冠状动脉血管形成和心肌供氧。 在收缩期,球囊放气,减少左心室后负荷,从而减少心肌需氧量。
其他名称:
|
研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
30天死亡率
大体时间:30天
|
住院后 30 天患者死亡率
|
30天
|
合作者和调查者
调查人员
- 首席研究员:Dafsah Juzar, MD、National Cardiovascular Center Harapan Kita Hospital Indonesia
出版物和有用的链接
一般刊物
- 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, Bohm 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 Oct 4;367(14):1287-96. doi: 10.1056/NEJMoa1208410. Epub 2012 Aug 26.
- Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, Buller CE, Jacobs AK, Slater JN, Col J, McKinlay SM, LeJemtel TH. 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 Aug 26;341(9):625-34. doi: 10.1056/NEJM199908263410901.
- Reynolds HR, Hochman JS. Cardiogenic shock: current concepts and improving outcomes. Circulation. 2008 Feb 5;117(5):686-97. doi: 10.1161/CIRCULATIONAHA.106.613596. No abstract available.
- Abraham WT, Adams KF, Fonarow GC, Costanzo MR, Berkowitz RL, LeJemtel TH, Cheng ML, Wynne J; ADHERE Scientific Advisory Committee and Investigators; ADHERE Study Group. In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medications: an analysis from the Acute Decompensated Heart Failure National Registry (ADHERE). J Am Coll Cardiol. 2005 Jul 5;46(1):57-64. doi: 10.1016/j.jacc.2005.03.051.
- Vincent JL, De Backer D. Circulatory shock. N Engl J Med. 2013 Oct 31;369(18):1726-34. doi: 10.1056/NEJMra1208943. No abstract available.
- Nabel EG, Braunwald E. A tale of coronary artery disease and myocardial infarction. N Engl J Med. 2012 Jan 5;366(1):54-63. doi: 10.1056/NEJMra1112570. No abstract available. Erratum In: N Engl J Med. 2012 Mar 8;366(10):970.
- Lindholm MG, Kober L, Boesgaard S, Torp-Pedersen C, Aldershvile J; Trandolapril Cardiac Evaluation study group. Cardiogenic shock complicating acute myocardial infarction; prognostic impact of early and late shock development. Eur Heart J. 2003 Feb;24(3):258-65. doi: 10.1016/s0195-668x(02)00429-3.
- Goldberg RJ, Spencer FA, Gore JM, Lessard D, Yarzebski J. 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 Mar 10;119(9):1211-9. doi: 10.1161/CIRCULATIONAHA.108.814947. Epub 2009 Feb 23.
- Barron HV, Every NR, Parsons LS, Angeja B, Goldberg RJ, Gore JM, Chou TM; Investigators in the National Registry of Myocardial Infarction 2. The use of intra-aortic balloon counterpulsation in patients with cardiogenic shock complicating acute myocardial infarction: data from the National Registry of Myocardial Infarction 2. Am Heart J. 2001 Jun;141(6):933-9. doi: 10.1067/mhj.2001.115295.
- Acharji S, Mathur A, Lakshmanadoss U, Prasad H, Singh M, Kaluski E. Have we given up on intra-aortic balloon counterpulsation in post-myocardial infarction cardiogenic shock? Clin Cardiol. 2013 Nov;36(11):704-10. doi: 10.1002/clc.22184. Epub 2013 Sep 17.
- Hochman JS, Sleeper LA, Webb JG, Dzavik V, Buller CE, Aylward P, Col J, White HD; SHOCK Investigators. Early revascularization and long-term survival in cardiogenic shock complicating acute myocardial infarction. JAMA. 2006 Jun 7;295(21):2511-5. doi: 10.1001/jama.295.21.2511.
- Werdan K, Russ M, Buerke M, Delle-Karth G, Geppert A, Schondube FA; German Cardiac Society; German Society of Intensive Care and Emergency Medicine; German Society for Thoracic and Cardiovascular Surgery; (Austrian Society of Internal and General Intensive Care Medicine; German Interdisciplinary Association of Intensive Care and Emergency Medicine; Austrian Society of Cardiology; German Society of Anaesthesiology and Intensive Care Medicine; German Society of Preventive Medicine and Rehabilitation. Cardiogenic shock due to myocardial infarction: diagnosis, monitoring and treatment: a German-Austrian S3 Guideline. Dtsch Arztebl Int. 2012 May;109(19):343-51. doi: 10.3238/arztebl.2012.0343. Epub 2012 May 11.
- Jeger RV, Urban P, Harkness SM, Tseng CH, Stauffer JC, Lejemtel TH, Sleeper LA, Pfisterer ME, Hochman JS. Early revascularization is beneficial across all ages and a wide spectrum of cardiogenic shock severity: A pooled analysis of trials. Acute Card Care. 2011 Mar;13(1):14-20. doi: 10.3109/17482941.2010.538696. Epub 2011 Jan 18.
- Overgaard CB, Dzavik V. Inotropes and vasopressors: review of physiology and clinical use in cardiovascular disease. Circulation. 2008 Sep 2;118(10):1047-56. doi: 10.1161/CIRCULATIONAHA.107.728840. No abstract available.
- Brodie BR, Stuckey TD, Hansen C, Muncy D. Intra-aortic balloon counterpulsation before primary percutaneous transluminal coronary angioplasty reduces catheterization laboratory events in high-risk patients with acute myocardial infarction. Am J Cardiol. 1999 Jul 1;84(1):18-23. doi: 10.1016/s0002-9149(99)00185-x.
- Sjauw KD, Engstrom AE, Vis MM, van der Schaaf RJ, Baan J Jr, Koch KT, de Winter RJ, Piek JJ, Tijssen JG, Henriques JP. A systematic review and meta-analysis of intra-aortic balloon pump therapy in ST-elevation myocardial infarction: should we change the guidelines? Eur Heart J. 2009 Feb;30(4):459-68. doi: 10.1093/eurheartj/ehn602. Epub 2009 Jan 23.
- Fuchs RM, Brin KP, Brinker JA, Guzman PA, Heuser RR, Yin FC. Augmentation of regional coronary blood flow by intra-aortic balloon counterpulsation in patients with unstable angina. Circulation. 1983 Jul;68(1):117-23. doi: 10.1161/01.cir.68.1.117.
- Abdel-Wahab M, Saad M, Kynast J, Geist V, Sherif MA, Richardt G, Toelg R. Comparison of hospital mortality with intra-aortic balloon counterpulsation insertion before versus after primary percutaneous coronary intervention for cardiogenic shock complicating acute myocardial infarction. Am J Cardiol. 2010 Apr 1;105(7):967-71. doi: 10.1016/j.amjcard.2009.11.021. Epub 2010 Feb 13.
- Schwarz B, Abdel-Wahab M, Robinson DR, Richardt G. Predictors of mortality in patients with cardiogenic shock treated with primary percutaneous coronary intervention and intra-aortic balloon counterpulsation. Med Klin Intensivmed Notfmed. 2016 Nov;111(8):715-722. doi: 10.1007/s00063-015-0118-8. Epub 2015 Nov 23.
- Fuernau G, Poenisch C, Eitel I, Denks D, de Waha S, Poss J, Heine GH, Desch S, Schuler G, Adams V, Werdan K, Zeymer U, Thiele H. Prognostic impact of established and novel renal function biomarkers in myocardial infarction with cardiogenic shock: A biomarker substudy of the IABP-SHOCK II-trial. Int J Cardiol. 2015 Jul 15;191:159-66. doi: 10.1016/j.ijcard.2015.04.242. Epub 2015 May 1.
- Attana P, Lazzeri C, Picariello C, Dini CS, Gensini GF, Valente S. Lactate and lactate clearance in acute cardiac care patients. Eur Heart J Acute Cardiovasc Care. 2012 Jun;1(2):115-21. doi: 10.1177/2048872612451168.
研究记录日期
研究主要日期
学习开始 (实际的)
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (实际的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
此信息直接从 clinicaltrials.gov 网站检索,没有任何更改。如果您有任何更改、删除或更新研究详细信息的请求,请联系 register@clinicaltrials.gov. clinicaltrials.gov 上实施更改,我们的网站上也会自动更新.