Clinical picture and risk prediction of short-term mortality in cardiogenic shock
Por:
Harjola V.-P., Lassus J., Sionis A., Køber L., Tarvasmäki T., Spinar J., Parissis J., Banaszewski M., Silva-Cardoso J., Carubelli V., Di Somma S., Tolppanen H., Zeymer U., Thiele H., Nieminen M.S., Mebazaa A.
Publicada:
1 ene 2015
Resumen:
Aims The aim of this study was to investigate the clinical picture and outcome of cardiogenic shock and to develop a risk prediction score for short-term mortality. Methods and results The CardShock study was a multicentre, prospective, observational study conducted between 2010 and 2012. Patients with either acute coronary syndrome (ACS) or non-ACS aetiologies were enrolled within 6 h from detection of cardiogenic shock defined as severe hypotension with clinical signs of hypoperfusion and/or serum lactate >2 mmol/L despite fluid resuscitation (n = 219, mean age 67, 74% men). Data on clinical presentation, management, and biochemical variables were compared between different aetiologies of shock. Systolic blood pressure was on average 78 mmHg (standard deviation 14 mmHg) and mean arterial pressure 57 (11) mmHg. The most common cause (81%) was ACS (68% ST-elevation myocardial infarction and 8% mechanical complications); 94% underwent coronary angiography, of which 89% PCI. Main non-ACS aetiologies were severe chronic heart failure and valvular causes. In-hospital mortality was 37% (n = 80). ACS aetiology, age, previous myocardial infarction, prior coronary artery bypass, confusion, low LVEF, and blood lactate levels were independently associated with increased mortality. The CardShock risk Score including these variables and estimated glomerular filtration rate predicted in-hospital mortality well (area under the curve 0.85). Conclusion Although most commonly due to ACS, other causes account for one-fifth of cases with shock. ACS is independently associated with in-hospital mortality. The CardShock risk Score, consisting of seven common variables, easily stratifies risk of short-term mortality. It might facilitate early decision-making in intensive care or guide patient selection in clinical trials. Trial registration NCT01374867. © 2015 The Authors. European Journal of Heart Failure © 2015 European Society of Cardiology.
Filiaciones:
Harjola V.-P.:
Emergency Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
Lassus J.:
Cardiology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
Sionis A.:
Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
Køber L.:
Rigshospitalet, Copenhagen University Hospital, Division of Heart Failure, Pulmonary Hypertension and Heart Transplantation, Copenhagen, Denmark
Tarvasmäki T.:
Emergency Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
Spinar J.:
University Hospital Brno, Department of Internal Medicine and Cardiology, Brno, Czech Republic
Parissis J.:
Attikon University Hospital, Heart Failure Clinic and Secondary Cardiology Department, Athens, Greece
Banaszewski M.:
Institute of Cardiology, Intensive Cardiac Therapy Clinic, Warsaw, Poland
Silva-Cardoso J.:
Department of Cardiology, University of Porto, São João Hospital Center, Porto, Portugal
Carubelli V.:
Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia, Italy
Di Somma S.:
Department of Medical Sciences and Translational Medicine, University of Rome Sapienza, Emergency Medicine sant'Andrea Hospital, Rome, Italy
Tolppanen H.:
Cardiology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
Zeymer U.:
Klinikum Ludwigshafen, Medizinische Kinik B, Ludwighafen, Germany
Thiele H.:
University of Lübeck, Medical Clinic II, Cardiology, Angiology and Intensive Care, Lübeck, Germany
Nieminen M.S.:
Cardiology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
Mebazaa A.:
INSERM U942, Hopital Lariboisiere, University Paris Diderot, Paris, France
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