Mukaida Takuto, Kataoka Yu, Murai Kota, Sawada Kenichiro, Iwai Takamasa, Matama Hideo, Honda Satoshi, Fujino Masashi, Yoneda Shuichi, Takagi Kensuke, Nakao Kazuhiro, Otsuka Fumiyuki, Tahara Yoshio, Asaumi Yasuhide, Noguchi Teruo
Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan.
Cardiovasc Diagn Ther. 2024 Dec 31;14(6):1148-1160. doi: 10.21037/cdt-24-226. Epub 2024 Nov 12.
The Society of Cardiovascular Angiography and Intervention (SCAI) has defined 5 stages of cardiogenic shock (CS). In patients with acute myocardial infarction (AMI) who initially present in stable hemodynamic condition (SCAI CS stage: A or B), CS stages could deteriorate despite therapeutic management. However, deterioration of SCAI CS stages after AMI remains to be fully characterized. Therefore, the current study sought to investigate the frequency and clinical characteristics about deterioration of SCAI CS stages after AMI.
We retrospectively analyzed 347 patients in a derivation cohort and 163 patients in a validation cohort who had AMI (SCAI shock stage upon arrival: A/B) and underwent percutaneous coronary intervention (PCI) at National Cerebral and Cardiovascular Center, Suita, Japan (enrolment period of study subjects: 2019.07.01-2022.09.30). Deterioration of CS (D-CS) was defined as SCAI shock stage C-E after PCI. Clinical characteristics and in-hospital mortality were compared according to D-CS status. Adjusted hazard ratios (HRs) for in-hospital mortality were calculated with multivariate Cox proportional hazards models that included variables with P<0.10 in univariate models. Uni- and multivariate logistic regression analyses were used to identify predictors of D-CS.
D-CS occurred in 17.3% (60/347) of the derivation cohort. Patients with D-CS had lower systolic blood pressure (BP) (P<0.001) and left ventricular ejection fraction (LVEF) (P<0.001) upon arrival with a higher proportion of initial Thrombolysis in Myocardial Infarction (TIMI) grade flow 0 or 1 (P=0.002). During hospitalization (13.9±9.4 days), D-CS was associated with higher in-hospital mortality [adjusted HR, 12.95; 95% confidence interval (CI): 1.46-114.97; P=0.02]. Initial systolic BP, LVEF, and TIMI grade flow 0 or 1 independently predicted D-CS. The D-CS risk score including these variables satisfactorily predicted D-CS [area under the curve (AUC), 0.749; 95% CI: 0.651-0.848] and in-hospital mortality (AUC, 0.961; 95% CI: 0.914-1.000) in the validation cohort.
D-CS occurred in 17.3% of patients with AMI initially presenting in stable condition and increased the risk of in-hospital mortality. Our D-CS risk score (initial systolic BP, LVEF, and TIMI grade flow) could be helpful to predict D-CS.
心血管造影和介入学会（SCAI）已定义了心源性休克（CS）的5个阶段。在最初呈现稳定血流动力学状态的急性心肌梗死（AMI）患者中（SCAI CS阶段：A或B），尽管进行了治疗管理，CS阶段仍可能恶化。然而，AMI后SCAI CS阶段的恶化情况仍有待充分描述。因此，本研究旨在调查AMI后SCAI CS阶段恶化的频率和临床特征。
我们回顾性分析了在日本吹田市国立脑血管病和心血管病中心接受经皮冠状动脉介入治疗（PCI）的347例推导队列患者和163例验证队列患者，这些患者患有AMI（入院时SCAI休克阶段：A/B）（研究对象的入组时间：2019年7月1日至2022年9月30日）。CS恶化（D-CS）定义为PCI后SCAI休克阶段C-E。根据D-CS状态比较临床特征和住院死亡率。使用多变量Cox比例风险模型计算住院死亡率的调整后风险比（HRs），该模型包括单变量模型中P<0.10的变量。使用单变量和多变量逻辑回归分析来确定D-CS的预测因素。
推导队列中17.3%（60/347）发生了D-CS。发生D-CS的患者入院时收缩压（BP）较低（P<0.001），左心室射血分数（LVEF）较低（P<0.001），初始心肌梗死溶栓（TIMI）血流分级0或1的比例较高（P=0.002）。在住院期间（13.9±9.4天），D-CS与较高的住院死亡率相关[调整后HR，12.95；95%置信区间（CI）：1.46-114.97；P=0.02]。初始收缩压、LVEF和TIMI血流分级0或1独立预测D-CS。包括这些变量的D-CS风险评分在验证队列中令人满意地预测了D-CS[曲线下面积（AUC），0.749；95%CI：0.651-0.848]和住院死亡率（AUC，0.961；95%CI：0.914-1.000）。
17.3%最初病情稳定的AMI患者发生了D-CS，这增加了住院死亡风险。我们的D-CS风险评分（初始收缩压、LVEF和TIMI血流分级）可能有助于预测D-CS。
