Clinical picture and risk prediction of short-term mortality in cardiogenic shock
Veli-Pekka Harjola, Johan Lassus, Alessandro Sionis, Lars Køber, Tuukka Tarvasmäki, Jindrich Spinar, John Parissis, Marek Banaszewski, Jose Silva-Cardoso, Valentina Carubelli, Salvatore Di Somma, Heli Tolppanen, Uwe Zeymer, Holger Thiele, Markku S Nieminen, Alexandre Mebazaa, CardShock Study Investigators, GREAT network, Katerina Koniari, Astrinos Voumvourakis, Apostolos Karavidas, Jordi Sans-Rosello, Montserrat Vila, Albert Duran-Cambra, Marco Metra, Michela Bulgari, Valentina Lazzarini, Jiri Parenica, Roman Stipal, Ondrej Ludka, Marie Palsuva, Eva Ganovska, Petr Kubena, Matias G Lindholm, Christian Hassager, Tom Bäcklund, Raija Jurkko, Kristiina Järvinen, Tuomo Nieminen, Kari Pulkki, Leena Soininen, Reijo Sund, Ilkka Tierala, Jukka Tolonen, Marjut Varpula, Tuomas Korva, Mervi Pietilä, Anne Pitkälä, Rossella Marino, Alexandra Sousa, Carla Sousa, Mariana Paiva, Inês Rangel, Rui Almeida, Teresa Pinho, Maria Júlia Maciel, Janina Stepinska, Anna Skrobisz, Piotr Góral, Veli-Pekka Harjola, Johan Lassus, Alessandro Sionis, Lars Køber, Tuukka Tarvasmäki, Jindrich Spinar, John Parissis, Marek Banaszewski, Jose Silva-Cardoso, Valentina Carubelli, Salvatore Di Somma, Heli Tolppanen, Uwe Zeymer, Holger Thiele, Markku S Nieminen, Alexandre Mebazaa, CardShock Study Investigators, GREAT network, Katerina Koniari, Astrinos Voumvourakis, Apostolos Karavidas, Jordi Sans-Rosello, Montserrat Vila, Albert Duran-Cambra, Marco Metra, Michela Bulgari, Valentina Lazzarini, Jiri Parenica, Roman Stipal, Ondrej Ludka, Marie Palsuva, Eva Ganovska, Petr Kubena, Matias G Lindholm, Christian Hassager, Tom Bäcklund, Raija Jurkko, Kristiina Järvinen, Tuomo Nieminen, Kari Pulkki, Leena Soininen, Reijo Sund, Ilkka Tierala, Jukka Tolonen, Marjut Varpula, Tuomas Korva, Mervi Pietilä, Anne Pitkälä, Rossella Marino, Alexandra Sousa, Carla Sousa, Mariana Paiva, Inês Rangel, Rui Almeida, Teresa Pinho, Maria Júlia Maciel, Janina Stepinska, Anna Skrobisz, Piotr Góral
Abstract
Aims: The aim of this study was to investigate the clinical picture and outcome of cardiogenic shock and to develop a risk prediction score for short-term mortality.
Methods and results: The CardShock study was a multicentre, prospective, observational study conducted between 2010 and 2012. Patients with either acute coronary syndrome (ACS) or non-ACS aetiologies were enrolled within 6 h from detection of cardiogenic shock defined as severe hypotension with clinical signs of hypoperfusion and/or serum lactate >2 mmol/L despite fluid resuscitation (n = 219, mean age 67, 74% men). Data on clinical presentation, management, and biochemical variables were compared between different aetiologies of shock. Systolic blood pressure was on average 78 mmHg (standard deviation 14 mmHg) and mean arterial pressure 57 (11) mmHg. The most common cause (81%) was ACS (68% ST-elevation myocardial infarction and 8% mechanical complications); 94% underwent coronary angiography, of which 89% PCI. Main non-ACS aetiologies were severe chronic heart failure and valvular causes. In-hospital mortality was 37% (n = 80). ACS aetiology, age, previous myocardial infarction, prior coronary artery bypass, confusion, low LVEF, and blood lactate levels were independently associated with increased mortality. The CardShock risk Score including these variables and estimated glomerular filtration rate predicted in-hospital mortality well (area under the curve 0.85).
Conclusion: Although most commonly due to ACS, other causes account for one-fifth of cases with shock. ACS is independently associated with in-hospital mortality. The CardShock risk Score, consisting of seven common variables, easily stratifies risk of short-term mortality. It might facilitate early decision-making in intensive care or guide patient selection in clinical trials.
Trial registration: NCT01374867.
Keywords: Acute coronary syndromes; Acute myocardial infarction; Cardiogenic shock; Management; Prognosis; Risk score.
© 2015 The Authors. European Journal of Heart Failure © 2015 European Society of Cardiology.
Source: PubMed