Systolic Blood Pressure and Microaxial Flow Pump-Associated Survival in Infarct-Related Cardiogenic Shock: A Post Hoc Analysis of the DanGer Shock Randomized Clinical Trial.

Systolic blood pressure (SBP) has been proposed as a modifier of the survival benefit.

收缩压（SBP）被认为是生存益处的调节因素。

Background

To investigate whether SBP at randomization modifies the survival benefit of microaxial flow pump treatment in ST-segment elevation myocardial infarction-related cardiogenic shock.

研究随机化时的收缩压是否改变了微轴流泵治疗ST段抬高型心肌梗死相关心源性休克的生存益处。

DESIGN, SETTING, AND PARTICIPANTS: This was a post hoc analysis of the Danish-German (DanGer) Shock open-label randomized clinical trial among adult patients with ST-segment elevation myocardial infarction complicated by cardiogenic shock, conducted between 2013 and 2023 at 14 tertiary invasive cardiac centers in Denmark, Germany, and the United Kingdom.

设计、环境和参与者：这是对2013年至2023年间在丹麦、德国和英国的14个三级侵入性心脏中心进行的丹麦-德国（DanGer）休克开放标签随机临床试验的回顾性分析，该试验涉及因心源性休克而复杂化的ST段抬高型心肌梗死的成年患者。

Data analysis was performed from January 7 to April 7, 2024.

数据分析工作从2024年1月7日持续至4月7日。

intervention

Microaxial flow pump therapy plus standard care vs standard care alone.

微轴流泵疗法联合标准治疗与单独标准治疗的比较。

main_outcomes_and_measures

All-cause mortality at 180 days according to randomization SBP.

根据随机化时的收缩压（SBP），180天的全因死亡率。

Results

Of 355 patients included in the DanGer Shock trial, 351 patients had available SBP at randomization (median [IQR] age, 69 [59-76] years; 277 [79%] male).

在DanGer Shock试验中，共有355名患者被纳入研究，其中351名患者在随机化时有可用的收缩压（中位数[四分位数间距]年龄为69[59-76]岁；277名[79%]为男性）。

In a dichotomized regression analysis, microaxial flow pump treatment significantly reduced mortality for SBPs lower than 82 mm Hg compared with standard care alone (odds ratio [OR], 0.34; 95% CI, 0.18-0.63; P < .001).

在二分回归分析中，微型轴流泵治疗显著降低了收缩压低于82毫米汞柱患者的死亡率，与单独标准治疗相比（比值比[OR]，0.34；95%置信区间，0.18-0.63；P < .001）。

This was not evident for higher pressures (OR, 0.96; 95% CI, 0.53-1.70; P = .90; P for interaction = .02).

对于更高压力的情况则没有这种效果（OR，0.96；95%置信区间，0.53-1.70；P = .90；交互作用P值 = .02）。

Kaplan-Meier survival analysis and spline regression analysis supported these findings (P for interaction = .02; P for nonlinearity = .01).

Kaplan-Meier生存分析和样条回归分析支持了这些发现（交互作用P值=0.02；非线性P值=0.01）。

conclusions_and_relevance

Randomization SBP was associated with the survival benefit of microaxial flow pump treatment, with the most hypotensive patients deriving the largest survival benefit.

随机化收缩压（SBP）与微型轴流泵治疗的生存益处相关，血压最低的患者获得了最大的生存益处。

Early SBP may help identify patients most likely to gain a net benefit from microaxial flow pump treatment.

早期收缩压（SBP）可能有助于识别最有可能从微型轴流泵治疗中获得净益处的患者。

Findings are hypothesis generating.

这些发现具有启发性假设的意义。

trial_registration

ClinicalTrials.gov Identifier: NCT01633502.

临床试验注册号：NCT01633502。