Rivas-Lasarte Mercedes, Sans-Roselló Jordi, Collado-Lledó Elena, González-Fernández Víctor, Noriega Francisco J, Hernández-Pérez Francisco J, Fernández-Martínez Juan, Ariza Albert, Lidón Rosa-Maria, Viana-Tejedor Ana, Segovia-Cubero Javier, Harjola Veli-Pekka, Lassus Johan, Thiele Holger, Sionis Alessandro
Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, CIBERCV, Spain.
Cardiology Service, Universitari Bellvitge Hospital-IDIBELL, Spain.
Eur Heart J Acute Cardiovasc Care. 2021 Mar 5;10(1):16–24. doi: 10.1177/2048872619895230. Epub 2020 Jan 31.
Mortality from cardiogenic shock remains high and early recognition and risk stratification are mandatory for optimal patient allocation and to guide treatment strategy. The CardShock and the Intra-Aortic Balloon Counterpulsation in Acute Myocardial Infarction Complicated by Cardiogenic Shock (IABP-SHOCK II) risk scores have shown good results in predicting short-term mortality in cardiogenic shock. However, to date, they have not been compared in a large cohort of ischaemic and non-ischaemic real-world cardiogenic shock patients.
The Red-Shock is a multicentre cohort of non-selected cardiogenic shock patients. We calculated the CardShock and IABP-SHOCK II risk scores in each patient and assessed discrimination and calibration.
We included 696 patients. The main cause of cardiogenic shock was acute coronary syndrome, occurring in 62% of the patients. Compared with acute coronary syndrome patients, non-acute coronary syndrome patients were younger and had a lower proportion of risk factors but higher rates of renal insufficiency; intra-aortic balloon pump was also less frequently used (31% vs 56%). In contrast, non-acute coronary syndrome patients were more often treated with mechanical circulatory support devices (11% vs 3%, <0.001 for both). Both risk scores were good predictors of in-hospital mortality in acute coronary syndrome patients and had similar areas under the receiver-operating characteristic curve (area under the curve: 0.742 for the CardShock vs 0.752 for IABP-SHOCK II, =0.65). Their discrimination performance was only modest when applied to non-acute coronary syndrome patients (0.648 vs 0.619, respectively, =0.31). Calibration was acceptable for both scores (Hosmer-Lemeshow =0.22 for the CardShock and 0.68 for IABP-SHOCK II).
In our cohort, both the CardShock and the IABP-SHOCK II risk scores were good predictors of in-hospital mortality in acute coronary syndrome-related cardiogenic shock.
心源性休克导致的死亡率仍然很高，早期识别和风险分层对于优化患者分配和指导治疗策略至关重要。CardShock风险评分和急性心肌梗死合并心源性休克的主动脉内球囊反搏（IABP-SHOCK II）风险评分在预测心源性休克短期死亡率方面已显示出良好效果。然而，迄今为止，尚未在大量缺血性和非缺血性真实世界心源性休克患者队列中对它们进行比较。
Red-Shock是一个未选择的心源性休克患者多中心队列。我们计算了每位患者的CardShock和IABP-SHOCK II风险评分，并评估了辨别力和校准情况。
我们纳入了696例患者。心源性休克的主要原因是急性冠状动脉综合征，占患者的62%。与急性冠状动脉综合征患者相比，非急性冠状动脉综合征患者更年轻，危险因素比例更低，但肾功能不全发生率更高；主动脉内球囊泵的使用频率也更低（31%对56%）。相比之下，非急性冠状动脉综合征患者更常接受机械循环支持装置治疗（11%对3%，两者均P<0.001）。两种风险评分都是急性冠状动脉综合征患者院内死亡率的良好预测指标，且在受试者工作特征曲线下面积相似（曲线下面积：CardShock为0.742，IABP-SHOCK II为0.752，P=0.65）。当应用于非急性冠状动脉综合征患者时，它们的辨别性能仅为中等（分别为0.648对0.619，P=0.31）。两种评分的校准均可接受（CardShock的Hosmer-Lemeshow检验P值为0.22，IABP-SHOCK II为0.68）。
在我们的队列中，CardShock和IABP-SHOCK II风险评分都是急性冠状动脉综合征相关心源性休克患者院内死亡率的良好预测指标。
