Emergency Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
Eur J Heart Fail. 2015 May;17(5):501-9. doi: 10.1002/ejhf.260. Epub 2015 Mar 28.
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.
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).
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.
NCT01374867.
本研究旨在探讨心原性休克的临床特征和转归，并建立短期死亡率的风险预测评分。
CardShock 研究是一项多中心、前瞻性、观察性研究，于 2010 年至 2012 年进行。在出现心原性休克后 6 小时内，患者被纳入研究，心原性休克的定义为严重低血压，伴有灌注不足的临床征象和/或血清乳酸>2mmol/L，尽管进行了液体复苏（n=219，平均年龄 67 岁，74%为男性）。比较不同病因休克患者的临床表现、治疗和生化变量。平均收缩压为 78mmHg（标准差 14mmHg），平均动脉压为 57（11）mmHg。最常见的病因（81%）是 ACS（68%ST 段抬高型心肌梗死和 8%机械并发症）；94%的患者进行了冠状动脉造影，其中 89%进行了 PCI。主要的非 ACS 病因是严重的慢性心力衰竭和瓣膜性病因。院内死亡率为 37%（n=80）。ACS 病因、年龄、既往心肌梗死、既往冠状动脉旁路移植术、意识障碍、低左心室射血分数和血乳酸水平与死亡率增加独立相关。包括这些变量和估算肾小球滤过率的 CardShock 风险评分能很好地预测院内死亡率（曲线下面积 0.85）。
尽管最常见的病因是 ACS，但其他病因占休克病例的五分之一。ACS 与院内死亡率独立相关。CardShock 风险评分由七个常见变量组成，可简单地分层短期死亡率风险。它可能有助于重症监护室的早期决策或指导临床试验中的患者选择。
NCT01374867。
