Continuum of Preshock to Classic Cardiogenic Shock in the Critical Care Cardiology Trials Network Registry

被引：3

作者：

Patel, Siddharth M. ^{[1
]}

Berg, David D. ^{[1
]}

Bohula, Erin A. ^{[1
]}

Baird-Zars, Vivian M. ^{[1
]}

Park, Jeong-Gun ^{[1
]}

Barnett, Christopher F. ^{[2
]}

Daniels, Lori B. ^{[3
]}

Fordyce, Christopher B. ^{[4
]}

Ghafghazi, Shahab ^{[5
]}

Goldfarb, Michael J. ^{[6
]}

Gorder, Kari ^{[7
]}

Kwon, Younghoon ^{[8
]}

Leibner, Evan ^{[9
]}

Menon, Venu ^{[10
]}

Potter, Brian J. ^{[11
,12
]}

Prasad, Rajnish ^{[13
]}

Solomon, Michael A. ^{[14
,15
]}

Teuteberg, Jeffrey J. ^{[16
]}

Thompson, Andrea D. ^{[17
]}

Zakaria, Sammy ^{[18
]}

Katz, Jason N. ^{[19
]}

van Diepen, Sean ^{[20
,21
]}

Morrow, David A. ^{[1
]}

机构：

[1] Harvard Med Sch, Brigham & Womens Hosp, Cardiovasc Div, Levine Cardiac Intens Care Unit,TIMI Study Grp,Dep, Boston, MA 02115 USA

[2] Univ Calif San Francisco, Dept Med, Div Cardiol, San Francisco, CA USA

[3] Univ Calif San Diego, Dept Med, Div Cardiovasc Med, La Jolla, CA USA

[4] Univ British Columbia, Vancouver Gen Hosp, Div Cardiol, Dept Med, Vancouver, BC, Canada

[5] Univ Louisville, Dept Med, Div Cardiovasc Med, Louisville, KY USA

[6] McGill Univ, Jewish Gen Hosp, Div Cardiol, Montreal, PQ, Canada

[7] Christ Hosp Heart & Vasc Inst, Cincinnati, OH USA

[8] Univ Washington, Div Cardiol, Seattle, WA USA

[9] Mt Sinai Hosp, Icahn Sch Med Mt Sinai, Dept Pulm & Crit Care, New York, NY USA

[10] Cleveland Clin Fdn, Cardiovasc Med, Cleveland, OH USA

[11] Ctr Hospitalier Univ Montreal CHUM Res Ctr, Montreal, PQ, Canada

[12] Cardiovasc Ctr, Montreal, PQ, Canada

[13] Wellstar Ctr Cardiovasc Care, Marietta, GA USA

[14] Natl Inst Hlth Clin Ctr, Crit Care Med Dept, Bethesda, MD USA

[15] NHLBI, NIH, Cardiovasc Branch, Bethesda, MD USA

[16] Stanford Univ, Dept Med, Div Cardiovasc Med, Stanford, CA USA

[17] Univ Michigan, Dept Internal Med, Div Cardiovasc Med, Ann Arbor, MI USA

[18] Johns Hopkins Univ, Sch Med, Dept Med, Div Cardiol, Baltimore, MD USA

[19] NYU, Dept Med, Div Cardiovasc Med, Sch Med, New York, NY USA

[20] Univ Alberta, Dept Crit Care Med, Edmonton, AB, Canada

[21] Univ Alberta, Dept Med, Div Cardiol, Edmonton, AB, Canada

来源：

JACC-HEART FAILURE | 2024年 / 12卷 / 09期

关键词：

cardiogenic shock; heart failure; preshock; risk stratification fi cation; MYOCARDIAL-INFARCTION; SUPPORT DEVICES;

D O I：

10.1016/j.jchf.2024.06.009

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND The prognostic implications of phenotypes along the preshock to cardiogenic shock (CS) continuum remain uncertain. OBJECTIVES This study sought to better characterize pre- or early shock and normotensive CS phenotypes and examine outcomes compared to those with conventional CS. METHODS The CCCTN (Critical Care Cardiology Trials Network) is a registry of contemporary cardiac intensive care units. Consecutive admissions (N 1 / 4 28,703 across 47 sites) meeting specific criteria based on hemodynamic variables, perfusion parameters, and investigator-reported CS were classified into 1 of 4 groups or none: isolated low cardiac output (CO), heart failure with isolated hypotension, normotensive CS, or SCAI (Society of Cardiovascular Angiography and Intervention) stage C CS. Outcomes of interest were in-hospital mortality and incidence of subsequent hypoperfusion among pre- and early shock states. RESULTS A total of 2,498 admissions were assigned to the 4 groups with the following distribution: 4.8% isolated low CO, 4.4% isolated hypotension, 12.1% normotensive CS, and 78.7% SCAI stage C CS. Overall in-hospital mortality was 21.3% (95% CI: 19.7%-23.0%), with a gradient across phenotypes (isolated low CO 3.6% [95% CI: 1.0%-9.0%]; isolated hypotension 11.0% [95% CI: 6.9%-16.6%]; normotensive CS 17.0% [95% CI 13.0%-21.8%]; SCAI stage C CS 24.0% [95% CI: 22.1%-26.0%]; global P < 0.001). Among those with an isolated low CO and isolated hypotension on admission, 47 (42.3%) and 56 (30.9%) subsequently developed hypoperfusion. CONCLUSIONS In a large contemporary registry of cardiac critical illness, there exists a gradient of mortality for phenotypes along the preshock to CS continuum with risk for subsequent worsening of preshock states. These data may inform refinement of CS definitions and severity staging. (JACC Heart Fail. 2024;12:1625-1635) (c) 2024 by the American College of Cardiology Foundation.

引用

页码：1625 / 1635

页数：11

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