Taha Hesham S, Gohar Ahmed, Ammar Walid, Alhossary Hossam, Adel Ahmed, Diab Reda, Mahfouz Hala, Shaker Mirna M, Samy Mina
Department of Cardiology, Faculty of Medicine, Cairo University, 27 Nafezet Sheem El Shafae St Kasr Al Ainy, Cairo, 11562, Egypt.
Shark Al Madina Hospital, Alexandria, Egypt.
Egypt Heart J. 2024 Jul 26;76(1):94. doi: 10.1186/s43044-024-00525-y.
Cardiogenic shock (CS) remains a major cause of morbidity and mortality, particularly in developing countries where there are limited resources and a lack of data on CS outcomes. This study aimed to investigate 30-day all-cause mortality in Egyptian patients with CS at tertiary referral centers.
This prospective, observational multicenter registry analyzed 16,681 patients from six cardiac centers, to evaluate the incidence, causes and predictors of CS-related mortality. Among the 529 diagnosed CS patients, 68.2% had an ischemic etiology. No discernable variations were observed in clinical or laboratory features, as well as mortality rates, between ischemic and non-ischemic CS patients. Within 30 days, 210 deaths (39.7%) occurred. Non-survivors with ischemic CS had a higher prevalence of diabetes, worsening renal function, and were more likely to receive multiple inotropes. Mortality did not significantly differ between acute coronary syndrome patients with ST elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) (42.7% vs. 43.7%, p < 0.887). However, anterior STEMI patients had significantly higher mortality than those with inferior STEMI (49.5% vs. 21.6%, p < 0.003). Multivariate regression analysis identified predictors of mortality in CS, including the median hospital stay duration, leucocyte count, alanine transaminase levels, highest creatinine levels, resuscitated cardiac arrest, and use of norepinephrine, epinephrine, and dopamine.
In an Egyptian cohort, CS incidence was 3.17%, with no mortality difference based on the underlying etiology. Independent predictors of 30-day all-cause mortality included worsening renal function, leucocyte count, resuscitated cardiac arrest, and use of multiple inotropes/vasopressors.
心源性休克（CS）仍然是发病和死亡的主要原因，尤其是在资源有限且缺乏CS结局数据的发展中国家。本研究旨在调查埃及三级转诊中心CS患者的30天全因死亡率。
这项前瞻性、观察性多中心注册研究分析了来自六个心脏中心的16,681名患者，以评估CS相关死亡率的发生率、原因和预测因素。在529例确诊的CS患者中，68.2%有缺血性病因。缺血性和非缺血性CS患者在临床或实验室特征以及死亡率方面未观察到明显差异。在30天内，发生了210例死亡（39.7%）。缺血性CS的非幸存者糖尿病患病率更高，肾功能恶化，且更有可能接受多种正性肌力药物治疗。ST段抬高型心肌梗死（STEMI）和非STEMI（NSTEMI）的急性冠状动脉综合征患者之间的死亡率无显著差异（42.7%对43.7%，p < 0.887）。然而，前壁STEMI患者的死亡率明显高于下壁STEMI患者（49.5%对21.6%，p < 0.003）。多变量回归分析确定了CS死亡率的预测因素，包括中位住院时间、白细胞计数、丙氨酸转氨酶水平、最高肌酐水平、复苏的心脏骤停以及去甲肾上腺素、肾上腺素和多巴胺的使用。
在埃及队列中，CS发生率为3.17%，基于潜在病因的死亡率无差异。30天全因死亡率的独立预测因素包括肾功能恶化、白细胞计数、复苏的心脏骤停以及使用多种正性肌力药物/血管加压药。
