Patrick R Lawler1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16, David D Berg4, Jeong-Gun Park4, Jason N Katz5, Vivian M Baird-Zars4, Gregory W Barsness6, Erin A Bohula4, Anthony P Carnicelli7, Sunit-Preet Chaudhry8, Jacob C Jentzer6,9, Venu Menon10, Thomas Metkus11, Jose Nativi-Nicolau12, Nicholas Phreaner13, Shashank S Sinha14, Jeffrey J Teuteberg15, Sean van Diepen16, David A Morrow4. 1. Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada. 2. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. 3. Ted Rogers Centre for Heart Research, Toronto, ON, Canada. 4. Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 5. Division of Cardiovascular Medicine, Duke University, Durham, NC. 6. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN. 7. Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. 8. Department of Cardiology, St. Vincent Hospital, Indianapolis, IN. 9. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN. 10. Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH. 11. John Hopkins University, Baltimore, MD. 12. Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT. 13. University of California San Diego, San Diego, CA. 14. Inova Heart and Vascular Institute, Inova Fairfax Medical Center, Falls Church, VA. 15. Department of Medicine, Stanford University School of Medicine, Stanford, CA. 16. Departments of Critical Care and Medicine (Cardiology), University of Alberta, Edmonton, AB, Canada.
Abstract
OBJECTIVES: Cardiogenic shock presents with variable severity. Categorizing cardiogenic shock into clinical stages may improve risk stratification and patient selection for therapies. We sought to determine whether a structured implementation of the 2019 Society for Cardiovascular Angiography and Interventions clinical cardiogenic shock staging criteria that is ascertainable in clinical registries discriminates mortality in a contemporary population with or at-risk for cardiogenic shock. DESIGN: We developed a pragmatic application of the Society for Cardiovascular Angiography and Interventions cardiogenic shock staging criteria-A (at-risk), B (beginning), C (classic cardiogenic shock), D (deteriorating), or E (extremis)-and examined outcomes by stage. SETTING: The Critical Care Cardiology Trials Network is an investigator-initiated multicenter research collaboration coordinated by the TIMI Study Group (Boston, MA). Consecutive admissions with or at-risk for cardiogenic shock during two annual 2-month collection periods (2017-2019) were analyzed. PATIENTS: Patients with or at-risk for cardiogenic shock. MEASUREMENTS AND MAIN RESULTS: Of 8,240 CICU admissions reviewed, 1,991 (24%) had or were at-risk for cardiogenic shock. Distributions across the five stages were as follows: A: 33%; B: 7%; C: 16%; D: 23%; and E: 21%. Overall in-hospital mortality among patients with established cardiogenic shock was 39%; however, mortality varied from only 15.8% to 32.1% to 62.5% across stages C, D, and E (Cochran-Armitage ptrend < 0.0001). The Society for Cardiovascular Angiography and Interventions stages improved mortality prediction beyond the Sequential Organ Failure Assessment and Intra-Aortic Balloon Pumpin Cardiogenic Shock II scores. CONCLUSIONS: Although overall mortality in cardiogenic shock remains high, it varies considerably based on clinical stage, identifying stage C as relatively lower risk. We demonstrate a pragmatic adaptation of the Society for Cardiovascular Angiography and Interventions cardiogenic shock stages that effectively stratifies mortality risk and could be leveraged for future clinical research.
OBJECTIVES:Cardiogenic shock presents with variable severity. Categorizing cardiogenic shock into clinical stages may improve risk stratification and patient selection for therapies. We sought to determine whether a structured implementation of the 2019 Society for Cardiovascular Angiography and Interventions clinical cardiogenic shock staging criteria that is ascertainable in clinical registries discriminates mortality in a contemporary population with or at-risk for cardiogenic shock. DESIGN: We developed a pragmatic application of the Society for Cardiovascular Angiography and Interventions cardiogenic shock staging criteria-A (at-risk), B (beginning), C (classic cardiogenic shock), D (deteriorating), or E (extremis)-and examined outcomes by stage. SETTING: The Critical Care Cardiology Trials Network is an investigator-initiated multicenter research collaboration coordinated by the TIMI Study Group (Boston, MA). Consecutive admissions with or at-risk for cardiogenic shock during two annual 2-month collection periods (2017-2019) were analyzed. PATIENTS: Patients with or at-risk for cardiogenic shock. MEASUREMENTS AND MAIN RESULTS: Of 8,240 CICU admissions reviewed, 1,991 (24%) had or were at-risk for cardiogenic shock. Distributions across the five stages were as follows: A: 33%; B: 7%; C: 16%; D: 23%; and E: 21%. Overall in-hospital mortality among patients with established cardiogenic shock was 39%; however, mortality varied from only 15.8% to 32.1% to 62.5% across stages C, D, and E (Cochran-Armitage ptrend < 0.0001). The Society for Cardiovascular Angiography and Interventions stages improved mortality prediction beyond the Sequential Organ Failure Assessment and Intra-Aortic Balloon Pumpin Cardiogenic Shock II scores. CONCLUSIONS: Although overall mortality in cardiogenic shock remains high, it varies considerably based on clinical stage, identifying stage C as relatively lower risk. We demonstrate a pragmatic adaptation of the Society for Cardiovascular Angiography and Interventions cardiogenic shock stages that effectively stratifies mortality risk and could be leveraged for future clinical research.
Authors: Ankeet S Bhatt; David D Berg; Erin A Bohula; Carlos L Alviar; Vivian M Baird-Zars; Christopher F Barnett; James A Burke; Anthony P Carnicelli; Sunit-Preet Chaudhry; Lori B Daniels; James C Fang; Christopher B Fordyce; Daniel A Gerber; Jianping Guo; Jacob C Jentzer; Jason N Katz; Norma Keller; Michael C Kontos; Patrick R Lawler; Venu Menon; Thomas S Metkus; Jose Nativi-Nicolau; Nicholas Phreaner; Robert O Roswell; Shashank S Sinha; R Jeffrey Snell; Michael A Solomon; Sean Van Diepen; David A Morrow Journal: J Card Fail Date: 2021-10 Impact factor: 6.592
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Authors: Héctor González-Pacheco; Rodrigo Gopar-Nieto; Diego Araiza-Garaygordobil; José Luis Briseño-Cruz; Guering Eid-Lidt; Jorge Arturo Ortega-Hernandez; Daniel Sierra-Lara; Alfredo Altamirano-Castillo; Salvador Mendoza-García; Daniel Manzur-Sandoval; Klayder Melissa Aguilar-Montaño; Heriberto Ontiveros-Mercado; Jorge Iván García-Espinosa; Pablo Esteban Pérez-Pinetta; Alexandra Arias-Mendoza Journal: PLoS One Date: 2022-08-16 Impact factor: 3.752