Rapid Classification and Treatment Algorithm of Cardiogenic Shock Complicating Acute Coronary Syndromes: The SAVE ACS Classification

Panoulas, Vasileios F.; Ilsley, Charles

doi:10.1155/2022/9948515

Cited by 4 publications

(6 citation statements)

References 29 publications

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“…This is important because the classic hypotension-based criteria prevalent in the shock literature can result in neglect of the ∼50% of hypoperfused ACS patients who present as normotensive. 18 , 19 …”

Section: Discussionmentioning

confidence: 99%

Complete revascularization is associated with higher mortality in patients with ST-elevation myocardial infarction, multi-vessel disease and shock defined by hyperlactataemia: results from the Harefield Shock Registry incorporating explainable machine learning

Tindale

Cretu

Meng

et al. 2023

European Heart Journal: Acute Cardiovascular Care

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Background and aims Revascularisation strategy for patients with STEMI and multi-vessel disease varies according to the patient’s cardiogenic shock status, but assessing shock acutely can be difficult. This paper examines the link between cardiogenic shock defined solely by a lactate of ≥2 mmol/L and mortality from complete vs culprit-only revascularisation in this cohort. Methods Patients presenting with STEMI, multi-vessel disease without severe left main stem stenosis and a lactate ≥2 mmol/L between 2011-21 were included. The primary endpoint was mortality at 30 days by revascularisation strategy for shocked patients. Secondary endpoints were mortality at 1-year and over a median follow-up of 30 months. Results 408 patients presented in shock. Mortality in the shock cohort was 27.5% at 30 days. Complete revascularisation was associated with higher mortality at 30 days (OR 2.1 (1.02-4.2), p = 0.043), one year (OR 2.4 (1.2-4.9), p = 0.01) and over 30 months follow-up (HR 2.2 (1.4-3.4), p < 0.001) compared to culprit lesion-only PCI. Mortality was again higher in the complete revascularisation group after propensity matching (p = 0.018) and inverse probability treatment weighting (HR 2.0 (1.3-3.0), p = 0.001). Furthermore, explainable machine learning demonstrated that complete revascularisation was behind only blood gas parameters and creatinine levels in importance for predicting 30-day mortality. Conclusions In patients presenting with STEMI and multi-vessel disease in shock defined solely by a lactate of ≥2 mmol/L, complete revascularisation is associated with higher mortality than culprit lesion-only PCI.

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Section: Discussionmentioning

confidence: 99%

Complete revascularization is associated with higher mortality in patients with ST-elevation myocardial infarction, multi-vessel disease and shock defined by hyperlactataemia: results from the Harefield Shock Registry incorporating explainable machine learning

Tindale

Cretu

Meng

et al. 2023

European Heart Journal: Acute Cardiovascular Care

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“…As a point of admission predictor, it is powerful, and has been shown to be predictive of mortality in several registry studies. 2 16 18 …”

Section: Discussionmentioning

confidence: 99%

“…For example, a raised lactate can be accompanied by normotension, potentially delaying escalation to dedicated shock teams. 2 …”

Section: Introductionmentioning

confidence: 99%

The BE-ALIVE score: assessing 30-day mortality risk in patients presenting with acute coronary syndromes

Tindale,

Panoulas

2023

Open Heart

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AimTo create and validate a simple scoring system for predicting 30-day mortality in patients presenting with acute coronary syndromes (ACS) at their moment of admission.Methods and results2407 consecutive patients presenting to Harefield Hospital with measured arterial blood gases, from January 2011 to December 2020, were studied to build the training set. 30-day mortality in this group was 17.2%. A scoring algorithm that was built using binary logistic regression of variables available on admission was then converted to an additive risk score. The resultant scoring system is the BE-ALIVE score, which incorporates the following factors:Base Excess (1 point for <−2 mmol/L), Age (<65 years: 0 points, 65–74: 1 point, 75–84: 2 points, ≥85: 3 points), Lactate (<2 mmol/L: 0 points, 2–4.9: 1 point, 5–9.9: 3 points, ≥10: 6 points), Intubated (2 points), Left Ventricular function (mildly impaired or better: −1 point, moderately impaired: 1 point, severely impaired: 3 points) and External/out of hospital cardiac arrest 2 points).The scoring system was validated using a testing set of 515 patients presenting to Harefield Hospital in 2021. The validation metrics were excellent with a c-statistic of 0.9, Brier’s score 0.06 vs a naïve classifier of 0.15, Spiegelhalter’s z-statistic probability of 0.267 and a calibration slope of 1.08.ConclusionThe BE-ALIVE score is a simple and accurate scoring system to predict 30-day mortality in patients presenting with ACS. Appreciating this mortality risk can allow prompt involvement of appropriate care such as the shock team.

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“…Age, left ventricular impairment, intubation, systolic BP, and the laboratory parameters lactate and base excess are characteristics mentioned in literature that proved to be associated with poor survival of the initial event [ 29 , 30 ]. However, it is unclear whether these factors also apply to the long-term survival of patients with AMI complicated by CS during the initial event.…”

Section: Discussionmentioning

confidence: 99%

Cardiogenic Shock Does Not Portend Poor Long-Term Survival in Patients Undergoing Primary Percutaneous Coronary Intervention

Steinacher

Hofer

Kazem

et al. 2022

JPM

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Although a strong association of cardiogenic shock (CS) with in-hospital mortality in patients with acute coronary syndrome (ACS) is well established, less attention has been paid to its prognostic influence on long-term outcome. We evaluated the impact of CS in 1173 patients undergoing primary percutaneous coronary interventions between 1997 and 2009. Patients were followed up until the primary study endpoint (cardiovascular mortality) was reached. Within the entire study population, 112 (10.4%) patients presented with CS at admission. After initial survival, CS had no impact on mortality (non-CS: 23.5% vs. CS: 24.0%; p = 0.923), with an adjusted hazard ratio of 1.18 (95% CI: 0.77–1.81; p = 0.457). CS patients ≥ 55 years (p = 0.021) with moderately or severely impaired left ventricular function (LVF; p = 0.039) and chronic kidney disease (CKD; p = 0.013) had increased risk of cardiovascular mortality during follow-up. The present investigation extends currently available evidence that cardiovascular survival in CS is comparable with non-CS patients after the acute event. CS patients over 55 years presenting with impaired LVF and CKD at the time of ACS are at increased risk for long-term mortality and could benefit from personalized secondary prevention.

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Rapid Classification and Treatment Algorithm of Cardiogenic Shock Complicating Acute Coronary Syndromes: The SAVE ACS Classification

Cited by 4 publications

References 29 publications

Complete revascularization is associated with higher mortality in patients with ST-elevation myocardial infarction, multi-vessel disease and shock defined by hyperlactataemia: results from the Harefield Shock Registry incorporating explainable machine learning

Complete revascularization is associated with higher mortality in patients with ST-elevation myocardial infarction, multi-vessel disease and shock defined by hyperlactataemia: results from the Harefield Shock Registry incorporating explainable machine learning

The BE-ALIVE score: assessing 30-day mortality risk in patients presenting with acute coronary syndromes

Cardiogenic Shock Does Not Portend Poor Long-Term Survival in Patients Undergoing Primary Percutaneous Coronary Intervention

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