Barrionuevo-Sánchez M Isabel, Ariza-Solé Albert, Prado Náyade Del, García María, Sánchez-Salado José Carlos, Lorente Victòria, Alegre Oriol, Llaó Isaac, Bernal José Luis, Fernández-Pérez Cristina, Galván-Román Francisco, Cuerda Francisco de la, Pascual Júlia, Cequier Angel, Comin-Colet Josep, Elola Francisco Javier
Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart. Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain.
Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart. Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain.
Hellenic J Cardiol. 2023 Jan-Feb;69:16-23. doi: 10.1016/j.hjc.2022.11.001. Epub 2022 Nov 2.
A significant proportion of cases of cardiogenic shock (CS) are due aetiologies other than acute coronary syndromes (non ACS-CS). We assessed differences regarding clinical profile, management, and prognosis according to the cause of CS among nonselected patients with CS from a large nationwide database.
We performed an observational study including patients admitted from the hospitals of the Spanish National Health System (SNHS) with a principal or secondary diagnosis code of CS (2016-2019). Data were obtained from the Minimum Basic Data Set (MBDS). Hospitals were classified according to the availability of cardiology related resources, as well as the availability of Intensive Cardiac Care Unit (ICCU).
A total of 10,826 episodes of CS were included, of whom 5,495 (50.8%) were non-ACS related. Non ACS-CS patients were younger (71.5 vs. 72.4 years) and had a lower burden of arteriosclerosis-related comorbidities. Non ACS-CS cases underwent less often invasive procedures and presented lower in-hospital mortality (57.1% vs. 61%,p < 0.001). The most common main diagnosis among non ACS-CS was acute decompensation of chronic heart failure (ADCHF) (35.4%). A lower risk-adjusted in-hospital mortality rate was observed in high volume hospitals (52.6% vs. 56.7%; p < 0.001), as well as in centers with ICCU (OR: 0.71; CI 95%: 0.58-0.87; p < 0.001).
More than a half of cases of CS were due to non-ACS causes. Non ACS-CS cases are a very heterogeneous group, with different clinical profile and management. Management at high-volume hospitals and availability of ICCU were associated with lower risk adjusted mortality among non ACS-CS patients.
心源性休克（CS）的很大一部分病例是由急性冠状动脉综合征以外的病因引起的（非急性冠状动脉综合征相关性心源性休克，non ACS-CS）。我们根据一个大型全国性数据库中未经过筛选的CS患者的心源性休克病因，评估了其临床特征、治疗和预后的差异。
我们进行了一项观察性研究，纳入了西班牙国家卫生系统（SNHS）医院收治的主要或次要诊断代码为CS的患者（2016 - 2019年）。数据来自最低基本数据集（MBDS）。医院根据心血管相关资源的可用性以及强化心脏护理单元（ICCU）的可用性进行分类。
共纳入10826例CS发作病例，其中5495例（50.8%）与非急性冠状动脉综合征相关。非急性冠状动脉综合征相关性心源性休克患者更年轻（71.5岁对72.4岁），且与动脉硬化相关的合并症负担更低。非急性冠状动脉综合征相关性心源性休克病例接受侵入性操作的频率较低，住院死亡率也较低（57.1%对61%，p < 0.001）。非急性冠状动脉综合征相关性心源性休克中最常见的主要诊断是慢性心力衰竭急性失代偿（ADCHF）（35.4%）。在高容量医院观察到风险调整后的住院死亡率较低（52.6%对56.7%；p < 0.001），在设有ICCU的中心也是如此（OR：0.71；95%CI：0.58 - 0.87；p < 0.001）。
超过一半的CS病例是由非急性冠状动脉综合征病因引起的。非急性冠状动脉综合征相关性心源性休克病例是一个非常异质性群体，具有不同的临床特征和治疗方式。高容量医院的治疗以及ICCU的可用性与非急性冠状动脉综合征相关性心源性休克患者风险调整后的较低死亡率相关。
