Department of Cardiovascular Medicine William Beaumont University Hospital Royal Oak MI.
Department of Advanced Heart Failure, Baylor Scott & White Health-The Heart Hospital Plano TX.
J Am Heart Assoc. 2024 Feb 6;13(3):e031803. doi: 10.1161/JAHA.123.031803. Epub 2024 Jan 31.
The Society for Cardiovascular Angiography and Interventions proposed a staging system (A-E) to predict prognosis in cardiogenic shock. Herein, we report clinical outcomes of the RECOVER III study for the first time, according to Society for Cardiovascular Angiography and Interventions shock classification.
The RECOVER III study is an observational, prospective, multicenter, single-arm, postapproval study of patients with acute myocardial infarction with cardiogenic shock undergoing percutaneous coronary intervention with Impella support. Patients enrolled in the RECOVER III study were assigned a baseline Society for Cardiovascular Angiography and Interventions shock stage. Staging was then repeated within 24 hours after initiation of Impella. Kaplan-Meier survival curve analyses were conducted to assess survival across Society for Cardiovascular Angiography and Interventions shock stages at both time points. At baseline assessment, 16.5%, 11.4%, and 72.2% were classified as stage C, D, and E, respectively. At ≤24-hour assessment, 26.4%, 33.2%, and 40.0% were classified as stage C, D, and E, respectively. Thirty-day survival among patients with stage C, D, and E shock at baseline was 59.7%, 56.5%, and 42.9%, respectively (=0.003). Survival among patients with stage C, D, and E shock at ≤24 hours was 65.7%, 52.1%, and 29.5%, respectively (<0.001). After multivariable analysis of impact of shock stage classifications at baseline and ≤24 hours, only stage E classification at ≤24 hours was a significant predictor of mortality (odds ratio, 4.8; <0.001).
In a real-world cohort of patients with acute myocardial infarction with cardiogenic shock undergoing percutaneous coronary intervention with Impella support, only stage E classification at ≤24 hours was significantly predictive of mortality, suggesting that response to therapy may be more important than clinical severity of shock at presentation.
心血管造影和介入学会提出了一个分期系统（A-E）来预测心原性休克的预后。在此，我们首次报告 RECOVER III 研究的临床结果，根据心血管造影和介入学会的休克分类。
RECOVER III 研究是一项观察性、前瞻性、多中心、单臂、上市后研究，纳入接受经皮冠状动脉介入治疗伴Impella 支持的心原性休克急性心肌梗死患者。RECOVER III 研究的患者被分配一个基线心血管造影和介入学会休克阶段。然后在启动 Impella 后 24 小时内再次进行分期。进行 Kaplan-Meier 生存曲线分析，以评估在两个时间点的心血管造影和介入学会休克阶段的生存情况。在基线评估时，分别有 16.5%、11.4%和 72.2%的患者被分类为 C、D 和 E 期。在≤24 小时评估时，分别有 26.4%、33.2%和 40.0%的患者被分类为 C、D 和 E 期。基线时 C、D 和 E 期休克患者的 30 天生存率分别为 59.7%、56.5%和 42.9%（=0.003）。≤24 小时时 C、D 和 E 期休克患者的生存率分别为 65.7%、52.1%和 29.5%（<0.001）。在基线和≤24 小时休克分期分类对死亡率的多变量分析中，只有≤24 小时的 E 期分类是死亡率的显著预测因素（比值比，4.8；<0.001）。
在接受 Impella 支持的经皮冠状动脉介入治疗伴心原性休克的急性心肌梗死真实世界患者队列中，只有≤24 小时的 E 期分类与死亡率显著相关，这表明治疗反应可能比就诊时休克的临床严重程度更重要。
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