Oyabu Kenjiro, Hattori Hidetoshi, Kikuchi Noriko, Haruki Shintaro, Minami Yuichiro, Ichihara Yuki, Saito Satoshi, Nunoda Shinichi, Niinami Hiroshi, Yamaguchi Junichi
Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan.
Catheter Cardiovasc Interv. 2024 Dec;104(7):1508-1516. doi: 10.1002/ccd.31219. Epub 2024 Sep 2.
Data on shock severity and bleeding events in patients with temporary mechanical circulatory support (tMCS) are limited. We investigated the relationship between the Society for Cardiovascular Angiography and Interventions (SCAI) shock stage classification and bleeding events in patients with tMCS.
We evaluated the data of 285 consecutive patients with tMCS who were admitted to our institution between June 2019 and May 2022. At the time of tMCS initiation, 81 patients (28.4%) were in SCAI stage A, 38 (13.3%) in stage B, 69 (24.2%) in stage C, 33 (11.6%) in stage D, and 64 (22.5%) in stage E. Multivariable logistic regression modeling was used to assess the association between the SCAI shock stage and in-hospital bleeding events.
In-hospital bleeding occurred in 100 patients (35.1%). The bleeding event rate increased incrementally across the SCAI shock stages (stage A, 11.1%; stage B, 15.8%; stage C, 37.7%; stage D, 54.6%; stage E, 64.1%). In-hospital bleeding was associated with the SCAI shock stage (p < 0.001). Compared with stage A, the adjusted odds ratios for in-hospital bleeding were 1.48 (95% confidence interval [CI] 0.47-4.66), 6.47 (95% CI 2.61-10.66), 11.59 (95% CI 3.77-35.64), and 7.85 (95% CI 2.51-24.55) for stages B, C, D, and E, respectively.
The SCAI shock stage predicted subsequent bleeding events in patients with tMCS. This simple scheme may be useful for tailored risk-based clinical assessment and management of patients with tMCS.
关于接受临时机械循环支持（tMCS）的患者的休克严重程度和出血事件的数据有限。我们研究了心血管造影和介入学会（SCAI）休克阶段分类与tMCS患者出血事件之间的关系。
我们评估了2019年6月至2022年5月期间连续入住我院的285例接受tMCS的患者的数据。在开始tMCS时，81例患者（28.4%）处于SCAI A期，38例（13.3%）处于B期，69例（24.2%）处于C期，33例（11.6%）处于D期，64例（22.5%）处于E期。采用多变量逻辑回归模型评估SCAI休克阶段与院内出血事件之间的关联。
100例患者（35.1%）发生院内出血。出血事件发生率在SCAI休克各阶段逐渐增加（A期，11.1%；B期，15.8%；C期，37.7%；D期，54.6%；E期，64.1%）。院内出血与SCAI休克阶段相关（p＜0.001）。与A期相比，B、C、D和E期院内出血的校正比值比分别为1.48（95%置信区间[CI]0.47 - 4.66）、6.47（95%CI 2.61 - 10.66）、11.59（95%CI 3.77 - 35.64）和7.85（95%CI 2.51 - 24.55）。
SCAI休克阶段可预测tMCS患者随后的出血事件。这个简单的方案可能有助于对tMCS患者进行基于风险的个性化临床评估和管理。
