Clinical picture and risk prediction of short‐term mortality in cardiogenic shock

Harjola, Veli‐Pekka; Lassus, Johan; Sionís, Alessandro; Køber, Lars; Tarvasmäki, Tuukka; Špinar, Jindřich; Parissis, John; Banaszewski, Marek; Silva-Cardoso, José; Carubelli, Valentina; Somma, Salvatore Di; Tolppanen, Heli; Zeymer, Uwe; Thiele, Holger; Nieminen, Markku S.; Mebazaa, Alexandre

doi:10.1002/ejhf.260

Cited by 619 publications

(651 citation statements)

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“…A contemporary registry has reported that as many as 81% of patients presenting with CS had an underlying acute coronary syndrome (ACS). 55 Thus, among patients with CS within the appropriate demographic or with risk factors for coronary artery disease, ACS should be the focus of initial diagnostic testing, and this testing should include an ECG within 10 minutes of presentation. 56 Although 5% to 12% of ACS cases are complicated by CS, this presentation is often associated with a large degree of at-risk myocardium.…”

Section: Pathogenesismentioning

confidence: 99%

“…In the non-ACS CS population, a contemporary registry (limited to 42 patients with non-ACS CS) reported an in-hospital mortality rate of 24% and that non-ACS pathogenesis was independently associated with better survival. 55 …”

Section: Contemporary Outcomes Prognosis and Resource Use Trends Inmentioning

confidence: 99%

“…98 The CardShock study was a series of 219 patients with all-cause CS and identified 7 variables associated with in-hospital mortality (c index 0.85), but it lacked external validation. 55 Among patients with an ACS complicated by CS, the GRACE (Global Registry of Acute Coronary Events) score has good discrimination and calibration for in-hospital and long-term mortality among all patients presenting with ACS, but it is not applicable to non-ACS presentations. 99 Additional published clinical, imaging, and hemodynamic variables associated with in-hospital mortality in the CS population include anoxic brain damage, end-organ hypoperfusion, elevated lactate, prior CABG, ACS pathogenesis, LV ejection fraction, RV function, pulmonary artery pulsatility index (defined as the ratio of pulmonary artery pulse pressure to right atrial pressure), mitral regurgitation, LV stroke work, cardiac power output, SBP, number of vasopressors, systemic inflammatory response syndrome, and TIMI (Thrombolysis in Myocardial Infarction) flow.…”

Section: Prognostic Models and Variablesmentioning

confidence: 99%

“…1,4,55 A recent analysis of patients with STEMI complicated by CS in the United States reported that the average total hospital cost was $41 774±45 252. 4 In the contemporary IABP-SHOCK II trial, there were higher average costs in the IABP arm (€33 155±14 593) than in the control arm (€32 538±14 031).…”

Section: Prognostic Models and Variablesmentioning

confidence: 99%

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Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Diepen¹,

Katz²,

Albert³

et al. 2017

Circulation

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Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities. Cardiogenic shock (CS) is a low-cardiac-output state resulting in life-threatening end-organ hypoperfusion and hypoxia.1,2 Acute myocardial infarction (MI) with left ventricular (LV) dysfunction remains the most frequent cause of CS. 1,3 Advances in reperfusion therapy have been associated with improvements in survival, but significant regional disparities in evidence-based care have been reported, and in-hospital mortality remains high (27%-51%).1,4-9 Management recommendations are distributed between disease-specific statements and guidelines, and a dedicated and comprehensive clinical resource in this area is lacking. Thus, consolidating the evidence to define contemporary best medical and surgical CS practices for both MI-associated CS and other types of CS may be an important step in knowledge translation to help attenuate disparities in evidence-based care.Regional systems of care coupled with treatment algorithms have improved survival in high-acuity time-sensitive conditions such as MI, out-of-hospital cardiac arrest (OHCA), and trauma.10-12 Applying a similar framework to CS management may lead to similar improvements in survival, and CS systems of care are emerging within existing regional cardiovascular emergency care networks; however, guidance from a national expert group on structure and systems of care has not been available. 13,14 Accordingly, the purposes of this American Heart Association (AHA) scientific statement on CS are to summarize our contemporary understanding of the epidemiology, pathophysiology, and in-hospital best care practices into a single clinical resource document; to suggest a stepwise management algorithm that integrates medical, surgical, and mechanical circulatory support (MCS) therapies; and to propose a Mission: Lifelinesupported pathway for the development of integrated regionalized CS systems of care. DEFINITION OF CSAcute cardiac hemodynamic instability may result from disorders that impair function of the myocardium, valves, conduction system, or pericardium, either in isolation HISTORICAL PERSPECTIVESBefore the routine use of early revascularization, MIassociated CS had an in-hospital mortality exceeding 80%. A registry trial of 250 patients with acute MI described the association between bedside physical examination (Killip classification) for the as...

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Section: Pathogenesismentioning

confidence: 99%

Section: Contemporary Outcomes Prognosis and Resource Use Trends Inmentioning

confidence: 99%

Section: Prognostic Models and Variablesmentioning

confidence: 99%

Section: Prognostic Models and Variablesmentioning

confidence: 99%

See 2 more Smart Citations

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Diepen¹,

Katz²,

Albert³

et al. 2017

Circulation

Self Cite

1,343

1,165

View full text Add to dashboard Cite

show abstract

“…However, these systems are more invasive and not available outside tertiary care centres. Although the most frequent cause of CS is acute coronary syndrome, non-ischaemic aetiology accounts for up to one-fifth of CS cases [7]. The haemodynamic needs may be different in non-ischaemic CS, where low output may be triggered by volume overload, versus AMI, where myocardial contractile reserve is acutely impaired.…”

Section: Introductionmentioning

confidence: 99%

First-Line Support by Intra-Aortic Balloon Pump in Non-Ischaemic Cardiogenic Shock in the Era of Modern Ventricular Assist Devices

et al. 2017

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Objectives: Little is known about circulatory support in cardiogenic shock (CS) from other causes than the acute coronary syndrome or after cardiotomy. We evaluated the effects of first-line intra-aortic balloon pump (IABP) support in this subpopulation of CS patients. Methods: A retrospective study was performed in 27 patients with CS from end-stage cardiomyopathy supported firstly by IABP in the years 2011-2016. Results: At 24 h, lactate decreased from 3.2 (2.1-6.8) to 1.8 (1.2-2.2) mmol/L (p < 0.001).Eighteen patients (67%) defined as IABP responders were successfully bridged to either recovery (n = 7), left ventricular assist device (n = 5), or heart transplantation (n = 6). IABP failed in 9 patients (non-responders, 33%) who either died (n = 7) or needed support by extracorporeal membrane oxygenation (n = 2). At 24 h of IABP support, urinary output was higher (2,660 [1,835-4,440] vs. 1,200 [649-2,385] mL; p = 0.02) and fluid balance more negative (-1,564 [-2,673 to -1,086] vs. -500 [-930 to +240] mL; p < 0.001) in responders than non-responders. Overall survival at 1 year was 63%. Conclusion: In most patients, first-line support by IABP in end-stage cardiomyopathy is associated with improvement in organ perfusion and clinical stabilisation for at least 24 h allowing time for decision making on next therapies.

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Cardiogenic Shock After Acute Myocardial Infarction

Samsky

Morrow

Proudfoot

et al. 2021

JAMA

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207

101

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ardiogenic shock (CS) is defined by systemic hypoperfusion and tissue hypoxia due to cardiac dysfunction. The most common etiology of CS is acute myocardial ischemia due to occlusion of an epicardial coronary artery, resulting in regional cardiac myocyte necrosis (acute myocardial infarction [AMI]) and loss of ventricular function. 1 CS is the leading cause of in-hospital death in patients with AMI. Between 40 000 and 50 000 patients in the US have CS associated with AMI each year, which correlates to an incidence of approximately 5% to 10% of all patients with AMI. [2][3][4][5] Thirty-day mortality is nearly 40% and approaches approximately 50% at 1 year (Box). [5][6][7][8] Severe left ventricular (LV) dysfunction is the most common presentation of CS in the setting of AMI, most frequently occurring after anterior MI. Of the 686 patients included in the Percutaneous Coronary Intervention Strategies with Acute Myocardial Infarction and Cardiogenic Shock (CULPRIT-SHOCK) trial, 288 (42.0%) had a left anterior descending MI and 53 (7.7%) had a left main coronary artery MI. 7 Few treatment approaches reduce short-or long-term morbidity and mortality in patients with CS. This review describes the pathophysiology, diagnosis, and management of CS in the setting of AMI. MethodsA literature search was performed that applied the Cochrane Highly Sensitive Search Strategy for randomized clinical trials (RCTs), a string for meta-analyses and systematic reviews, and established Medical Subject Headings for "cardiogenic shock" and "treatment" to the PubMed and Cochrane databases for articles published from January 1, 1995, through August 5, 2021. The literature search identified 1552 articles. The authors prioritized RCTs, meta-analyses, and larger observational studies. A total of 46 papers were included, including 12 randomized trials, 2 metaanalyses, 1 systematic review, and 31 observational studies.

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Clinical picture and risk prediction of short‐term mortality in cardiogenic shock

Abstract: NCT01374867.

Cited by 619 publications

References 30 publications

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

First-Line Support by Intra-Aortic Balloon Pump in Non-Ischaemic Cardiogenic Shock in the Era of Modern Ventricular Assist Devices

Cardiogenic Shock After Acute Myocardial Infarction

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