The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA.
Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
J Am Coll Cardiol. 2022 Jul 19;80(3):185-198. doi: 10.1016/j.jacc.2022.04.049.
Risk-stratifying patients with cardiogenic shock (CS) is a major unmet need. The recently proposed Society for Cardiovascular Angiography and Interventions (SCAI) staging system for CS severity lacks uniform criteria defining each stage.
The purpose of this study was to test parameters that define SCAI stages and explore their utility as predictors of in-hospital mortality in CS.
The CS Working Group registry includes patients from 17 hospitals enrolled between 2016 and 2021 and was used to define clinical profiles for CS. We selected parameters of hypotension and hypoperfusion and treatment intensity, confirmed their association with mortality, then defined formal criteria for each stage and tested the association between both baseline and maximum Stage and mortality.
Of 3,455 patients, CS was caused by heart failure (52%) or myocardial infarction (32%). Mortality was 35% for the total cohort and higher among patients with myocardial infarction, out-of-hospital cardiac arrest, and treatment with increasing numbers of drugs and devices. Systolic blood pressure, lactate level, alanine transaminase level, and systemic pH were significantly associated with mortality and used to define each stage. Using these criteria, baseline and maximum stages were significantly associated with mortality (n = 1,890). Lower baseline stage was associated with a higher incidence of stage escalation and a shorter duration of time to reach maximum stage.
We report a novel approach to define SCAI stages and identify a significant association between baseline and maximum stage and mortality. This approach may improve clinical application of the staging system and provides new insight into the trajectory of hospitalized CS patients. (Cardiogenic Shock Working Group Registry [CSWG]; NCT04682483).
对心源性休克（CS）患者进行风险分层是一个未满足的主要需求。最近提出的心血管血管造影和介入学会（SCAI）CS 严重程度分期系统缺乏定义每个阶段的统一标准。
本研究的目的是测试定义 SCAI 分期的参数，并探讨其作为 CS 住院死亡率预测指标的效用。
CS 工作组注册登记包括 2016 年至 2021 年期间来自 17 家医院的患者，用于定义 CS 的临床特征。我们选择低血压和低灌注以及治疗强度的参数，确认其与死亡率的相关性，然后为每个阶段定义正式标准，并测试基线和最大阶段与死亡率之间的相关性。
在 3455 例患者中，CS 由心力衰竭（52%）或心肌梗死（32%）引起。总队列的死亡率为 35%，心肌梗死、院外心脏骤停和使用越来越多的药物和器械治疗的患者死亡率更高。收缩压、乳酸水平、丙氨酸转氨酶水平和全身 pH 值与死亡率显著相关，并用于定义每个阶段。使用这些标准，基线和最大阶段与死亡率显著相关（n=1890）。较低的基线阶段与更高的阶段升级发生率和达到最大阶段的时间更短相关。
我们报告了一种定义 SCAI 分期的新方法，并确定了基线和最大分期与死亡率之间的显著关联。这种方法可能会改善分期系统的临床应用，并为住院 CS 患者的轨迹提供新的见解。（心源性休克工作组注册登记[CSWG]；NCT04682483）。
