Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Eur Heart J Acute Cardiovasc Care. 2021 Aug 24;10(6):604-612. doi: 10.1093/ehjacc/zuaa035.
Cardiogenic shock (CS) is associated with poor outcomes in older patients, but it remains unclear if this is due to higher shock severity. We sought to determine the associations between age and shock severity on mortality among patients with CS.
Patients with a diagnosis of CS from Mayo Clinic (2007-15) and University Clinic Hamburg (2009-17) were subdivided by age. Shock severity was graded using the Society for Cardiovascular Angiography and Intervention (SCAI) shock stages. Predictors of 30-day survival were determined using Cox proportional-hazards analysis. We included 1749 patients (934 from Mayo Clinic and 815 from University Clinic Hamburg), with a mean age of 67.6 ± 14.6 years, including 33.6% females. Acute coronary syndrome was the cause of CS in 54.0%. The distribution of SCAI shock stages was 24.1%; C, 28.0%; D, 33.2%; and E, 14.8%. Older patients had similar overall shock severity, more co-morbidities, worse kidney function, and decreased use of mechanical circulatory support compared to younger patients. Overall 30-day survival was 53.3% and progressively decreased as age or SCAI shock stage increased, with a clear gradient towards lower 30-day survival as a function of increasing age and SCAI shock stage. Progressively older age groups had incrementally lower adjusted 30-day survival than patients aged <50 years.
Older patients with CS have lower short-term survival, despite similar shock severity, with a high risk of death in older patients with more severe shock. Further research is needed to determine the optimal treatment strategies for older CS patients.
心原性休克（CS）与老年患者的预后不良相关，但尚不清楚这是否是由于休克严重程度更高所致。我们旨在确定 CS 患者的年龄与休克严重程度与死亡率之间的关系。
根据年龄将 Mayo 诊所（2007-15 年）和汉堡大学诊所（2009-17 年）的 CS 诊断患者进行细分。使用心血管血管造影和介入学会（SCAI）休克阶段对休克严重程度进行分级。使用 Cox 比例风险分析确定 30 天生存率的预测因素。我们纳入了 1749 名患者（934 名来自 Mayo 诊所，815 名来自汉堡大学诊所），平均年龄为 67.6±14.6 岁，其中 33.6%为女性。急性冠状动脉综合征是 CS 的病因占 54.0%。SCAI 休克阶段的分布为 24.1%；C 级为 28.0%；D 级为 33.2%；E 级为 14.8%。与年轻患者相比，老年患者的整体休克严重程度相似，但合并症更多，肾功能更差，机械循环支持的使用率更低。总体 30 天生存率为 53.3%，随着年龄或 SCAI 休克阶段的增加而逐渐降低，随着年龄和 SCAI 休克阶段的增加，30 天生存率呈明显下降趋势。年龄较大的年龄组调整后的 30 天生存率明显低于<50 岁的患者。
尽管休克严重程度相似，但 CS 老年患者的短期生存率较低，且休克程度较重的老年患者死亡风险较高。需要进一步研究以确定老年 CS 患者的最佳治疗策略。
