Ton Van-Khue, Li Song, John Kevin, Li Borui, Zweck Elric, Kanwar Manreet K, Sinha Shashank S, Hernandez-Montfort Jaime, Garan A Reshad, Goodman Rachel, Faugno Anthony, Farr Maryjane, Hall Shelley, Kataria Rachna, Guglin Maya, Vorovich Esther, Pahuja Mohit, Vallabhajosyula Saraschandra, Nathan Sandeep, Abraham Jacob, Harwani Neil M, Hickey Gavin W, Schwartzman Andrew D, Khalife Wissam, Mahr Claudius, Kim Ju H, Bhimaraj Arvind, Sangal Paavni, Kong Qiuyue, Walec Karol D, Zazzali Peter, Fried Justin, Burkhoff Daniel, Kapur Navin K
Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
Institute for Advanced Cardiac Care, Medical City Healthcare, Dallas, Texas, USA.
J Am Coll Cardiol. 2024 Aug 1. doi: 10.1016/j.jacc.2024.04.069.
The Cardiogenic Shock Working Group-modified Society for Cardiovascular Angiography and Interventions (CSWG-SCAI) staging was developed to risk stratify cardiogenic shock (CS) severity. Data showing progressive changes in SCAI stages and outcomes are limited.
We investigated serial changes in CSWG-SCAI stages and outcomes of patients presenting with cardiogenic shock complicating acute myocardial infarction (MI-CS) and heart failure-related CS (HF-CS).
The multicenter CSWG registry was queried. CSWG-SCAI stages were computed at CS diagnosis and 24, 48, and 72 hours.
A total of 3,268 patients (57% HF-CS; 27% MI-CS) were included. At CS diagnosis, CSWG-SCAI stage breakdown was 593 (18.1%) stage B, 528 (16.2%) stage C, 1,659 (50.8%) stage D, and 488 (14.9%) noncardiac arrest stage E. At 24 hours, >50% of stages B and C patients worsened, but 86% of stage D patients stayed at stage D. Among stage E patients, 54% improved to stage D and 36% stayed at stage E by 24 hours. Minimal SCAI stage changes occurred beyond 24 hours. SCAI stage trajectories were similar between MI-CS and HF-CS groups. Within 24 hours, unadjusted mortality rates of patients with any SCAI stage worsening or improving were 44.6% and 34.2%, respectively. Patients who presented in or progressed to stage E by 24 hours had the worst prognosis. Survivors had lower lactate than nonsurvivors.
Most patients with CS changed SCAI stages within 24 hours from CS diagnosis. Stage B patients were at high risk of worsening shock severity by 24 hours, associated with excess mortality. Early CS recognition and serial assessment may improve risk stratification.
心源性休克工作组修订的心血管造影和介入学会（CSWG-SCAI）分期旨在对心源性休克（CS）的严重程度进行风险分层。显示SCAI分期和预后进行性变化的数据有限。
我们调查了并发急性心肌梗死的心源性休克（MI-CS）和心力衰竭相关性心源性休克（HF-CS）患者的CSWG-SCAI分期及预后的系列变化。
查询了多中心CSWG注册登记资料。在CS诊断时以及24、48和72小时计算CSWG-SCAI分期。
共纳入3268例患者（57%为HF-CS；27%为MI-CS）。在CS诊断时，CSWG-SCAI分期分布为B期593例（18.1%）、C期528例（16.2%）、D期1659例（50.8%）和非心脏骤停E期488例（14.9%）。在24小时时，超过50%的B期和C期患者病情恶化，但86%的D期患者仍处于D期。在E期患者中，到24小时时，54%改善为D期，36%仍处于E期。24小时后SCAI分期变化极小。MI-CS组和HF-CS组的SCAI分期轨迹相似。在24小时内，任何SCAI分期恶化或改善的患者未经调整的死亡率分别为44.6%和34.2%。在24小时时处于或进展至E期的患者预后最差。幸存者的乳酸水平低于非幸存者。
大多数CS患者在CS诊断后24小时内SCAI分期发生变化。B期患者在24小时内休克严重程度恶化风险高，与死亡率过高相关。早期识别CS并进行系列评估可能改善风险分层。
