Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada.
J Am Coll Cardiol. 2019 Oct 29;74(17):2117-2128. doi: 10.1016/j.jacc.2019.07.077. Epub 2019 Sep 20.
A new 5-stage cardiogenic shock (CS) classification scheme was recently proposed by the Society for Cardiovascular Angiography and Intervention (SCAI) for the purpose of risk stratification.
This study sought to apply the SCAI shock classification in a cardiac intensive care unit (CICU) population.
The study retrospectively analyzed Mayo Clinic CICU patients admitted between 2007 and 2015. SCAI CS stages A through E were classified retrospectively using CICU admission data based on the presence of hypotension or tachycardia, hypoperfusion, deterioration, and refractory shock. Hospital mortality in each SCAI shock stage was stratified by cardiac arrest (CA).
Among the 10,004 unique patients, 43.1% had acute coronary syndrome, 46.1% had heart failure, and 12.1% had CA. The proportion of patients in SCAI CS stages A through E was 46.0%, 30.0%, 15.7%, 7.3%, and 1.0% and unadjusted hospital mortality in these stages was 3.0%, 7.1%, 12.4%, 40.4%, and 67.0% (p < 0.001), respectively. After multivariable adjustment, each higher SCAI shock stage was associated with increased hospital mortality (adjusted odds ratio: 1.53 to 6.80; all p < 0.001) compared with SCAI shock stage A, as was CA (adjusted odds ratio: 3.99; 95% confidence interval: 3.27 to 4.86; p < 0.001). Results were consistent in the subset of patients with acute coronary syndrome or heart failure.
When assessed at the time of CICU admission, the SCAI CS classification, including presence or absence of CA, provided robust hospital mortality risk stratification. This classification system could be implemented as a clinical and research tool to identify, communicate, and predict the risk of death in patients with, and at risk for, CS.
最近，心血管血管造影和介入学会（SCAI）提出了一种新的 5 期心源性休克（CS）分类方案，旨在进行风险分层。
本研究旨在将 SCAI 休克分类应用于心脏重症监护病房（CICU）人群。
该研究回顾性分析了 2007 年至 2015 年间在梅奥诊所 CICU 住院的患者。根据低血压或心动过速、低灌注、恶化和难治性休克的存在，使用 CICU 入院数据对 SCAI CS 阶段 A 至 E 进行回顾性分类。根据心脏骤停（CA）对每个 SCAI 休克阶段的住院死亡率进行分层。
在 10004 名患者中，43.1%患有急性冠状动脉综合征，46.1%患有心力衰竭，12.1%患有 CA。SCAI CS 阶段 A 至 E 的患者比例分别为 46.0%、30.0%、15.7%、7.3%和 1.0%，这些阶段的未调整住院死亡率分别为 3.0%、7.1%、12.4%、40.4%和 67.0%（p<0.001）。经过多变量调整后，与 SCAI 休克阶段 A 相比，每个更高的 SCAI 休克阶段与更高的住院死亡率相关（调整后的优势比：1.53 至 6.80；所有 p<0.001），CA 也是如此（调整后的优势比：3.99；95%置信区间：3.27 至 4.86；p<0.001）。在急性冠状动脉综合征或心力衰竭患者亚组中，结果一致。
在 CICU 入院时评估时，SCAI CS 分类（包括 CA 的存在与否）提供了可靠的住院死亡率风险分层。该分类系统可作为一种临床和研究工具，用于识别、沟通和预测 CS 患者和高危患者的死亡风险。
