Wang Yiwen, Li Chenglong, Wang Liangshan, Hao Xing, Wang Xiaomeng, Wu Tingting, Hou Dengbang, Jia Ming, Yang Feng, Du Zhongtao, Wang Hong, Hou Xiaotong
Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
JACC Asia. 2025 May;5(5):663-676. doi: 10.1016/j.jacasi.2025.01.007. Epub 2025 Mar 18.
Cardiogenic shock (CS) is a life-threatening hemodynamic state. Patients with differing shock severity show varying responsiveness to clinical interventions. CS also occurs in patients who have undergone cardiac surgery. A few evaluation systems have been developed for postcardiotomy patients. The Society for Cardiovascular Angiography and Intervention (SCAI) has developed a new classification scheme for CS.
This study aimed to assess the parameters that define the stages of CS and the diagnostic utility of an SCAI-based CS classification system for patients undergoing cardiac surgery to inform the prediction of outcomes.
This single-center, retrospective, observational study included 8,335 consecutive adult patients undergoing cardiac surgery from January to December 2022. This cohort was divided into 5 groups based on lactate and types of intervention received, including vasopressors and mechanical circulatory support systems. The primary outcome was in-hospital mortality.
CS occurred in 970 (11.1%) patients of this cohort. The frequencies of distribution of various postcardiotomy shock stages differed significantly: stage A = 4,747 (57.0%), stage B = 2,658 (31.9%), stage C = 779 (9.3%), stage D = 64 (0.8%), and stage E = 87 (1.0%) (P < 0.001) patients. In-hospital mortality was 1.1% (94 of 8,335). A progressive increase in the stage of the disease led to a clear stepwise increase in in-hospital mortality: Stage A = 0.4% (19 of 4747), Stage B = 0.8% (21 of 2658), Stage C = 2.8% (22 of 779), Stage D = 7.8% (5 of 64), and Stage E = 31.0% (27 of 87) (P < 0.001). The area under the receiver-operating curve of this classification for postcardiotomy CS was 0.781 (95% CI: 0.746-0.815).
In this single-center postcardiotomy population, CS occurred in 11.1% of patients. Postcardiotomy SCAI-derived criteria for CS severity suggested a good correlation with in-hospital mortality.
心源性休克（CS）是一种危及生命的血流动力学状态。不同休克严重程度的患者对临床干预的反应各不相同。CS也发生在接受心脏手术的患者中。已经为心脏手术后的患者开发了一些评估系统。心血管造影和介入学会（SCAI）已经为CS制定了一种新的分类方案。
本研究旨在评估定义CS阶段的参数以及基于SCAI的CS分类系统对接受心脏手术患者的诊断效用，以为预后预测提供信息。
这项单中心、回顾性、观察性研究纳入了2022年1月至12月连续接受心脏手术的8335例成年患者。该队列根据乳酸水平和接受的干预类型（包括血管升压药和机械循环支持系统）分为5组。主要结局是住院死亡率。
该队列中有970例（11.1%）患者发生CS。各种心脏术后休克阶段的分布频率差异显著：A期 = 4747例（57.0%），B期 = 2658例（31.9%），C期 = 779例（9.3%），D期 = 64例（0.8%），E期 = 87例（1.0%）（P < 0.001）。住院死亡率为1.1%（8335例中的94例）。疾病阶段的逐渐增加导致住院死亡率明显逐步上升：A期 = 0.4%（4747例中的19例），B期 = 0.8%（2658例中的21例），C期 = 2.8%（779例中的22例），D期 = 7.8%（64例中的5例），E期 = 31.0%（87例中的27例）（P < 0.001）。该分类对心脏术后CS的受试者工作特征曲线下面积为0.781（95%CI：0.746 - 0.815）。
在这个单中心心脏术后人群中，11.1%的患者发生CS。基于SCAI得出的心脏术后CS严重程度标准与住院死亡率显示出良好的相关性。
