Rationale and design of DanGer shock: Danish-German cardiogenic shock trial

Udesen, Nanna Junker; Møller, Jacob Eifer; Lindholm, Matias Greve; Eiskjær, Hans; Schäfer, Andreas; Werner, Nikos; Holmvang, Lene; Terkelsen, Christian Juhl; Jensen, Lisette Okkels; Junker, Anders; Schmidt, Henrik; Wachtell, Kristian; Thiele, Holger; Engstrøm, Thomas; Hassager, Christian

doi:10.1016/j.ahj.2019.04.019

Cited by 179 publications

(140 citation statements)

References 31 publications

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“…These patient populations have not been covered by previous randomized trials on this topic, which mostly use hypoperfusion (e.g., elevated lactate) as an inclusion criterion. 6,8,9 However, preventing the development or worsening of CS in the respective patient populations is intriguing, given the paucity of effective treatments for established CS. 1 Based on a previous study, it was expected that the majority of patients with CS are already admitted with CS.…”

Section: Discussionmentioning

confidence: 99%

Application of the SCAI classification in a cohort of patients with cardiogenic shock

Schrage¹,

Dabboura²,

Yan³

et al. 2020

Cathet Cardio Intervent

144

134

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Background The Society of Cardiovascular Angiography and Interventions (SCAI) have recently proposed a new classification of cardiogenic shock (CS) dividing patients into five subgroups. Objective Aim of this study was to apply the SCAI classification to a cohort of patients presenting with CS and to evaluate its ability to predict 30‐day survival. Methods SCAI CS subgroups were interpreted based on the recent consensus statement and then applied to N = 1,007 consecutive patients presenting with CS or large myocardial infarction (MI) between October 2009 and October 2017. The association between SCAI classification and 30‐day all‐cause mortality was assessed by logistic regression analysis. Results Mean age in the study cohort was 67 (±15) years, 72% were male. Mean lactate at baseline was 6.05 (±5.13) mmol/l and 51% of the patients had prior cardiac arrest. Overall survival probability was 50.6% (95% confidence interval [CI] 47.5–54.0%). In view of the SCAI classification, the survival probability was 96.4% (95% CI 93.7–99.0%) in class A, 66.1% (95% CI 50.2–87.1%) in class B, 46.1% (95% CI 40.6–52.4%) in class C, 33.1% (95% CI 26.6–41.1%) in class D, and 22.6% (95% CI 17.1–30.0%) in class E. Higher SCAI classification was significantly associated with lower 30‐day survival (p < .01). Conclusion In this large clinical cohort, the SCAI classification was significantly associated with 30‐day survival. This finding supports the rationale of the SCAI CS classification and calls for a validation in a prospective trial.

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Section: Discussionmentioning

confidence: 99%

Application of the SCAI classification in a cohort of patients with cardiogenic shock

Schrage¹,

Dabboura²,

Yan³

et al. 2020

Cathet Cardio Intervent

144

134

View full text Add to dashboard Cite

show abstract

“…Aside from early revascularization for patients with ischemic CS (e.g., CS due to acute myocardial infarction), there is no treatment which has shown to improve outcomes in CS [3,4]. Importantly, research on CS is focused on patients with ischemic CS, and past as well as ongoing randomized controlled outcome trials in this area used "CS due to ischemic origin" as a major enrolment criterion [5][6][7][8]. However, recent studies have indicated that only a minority of CS cases are explained by acute myocardial infarction, whereas the majority were non-ischemic CS cases, caused by, e.g., decompensated heart failure [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Patient Characteristics, Treatment and Outcome in Non-Ischemic vs. Ischemic Cardiogenic Shock

Schrage

Weimann

Dabboura

et al. 2020

JCM

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Aim: Evidence on non-ischemic cardiogenic shock (CS) is scarce. The aim of this study was to investigate differences in patient characteristics, use of treatments and outcomes in patients with non-ischemic vs. ischemic CS. Methods: Patients with CS admitted between October 2009 and October 2017 were identified and stratified as non-ischemic/ischemic CS based on the absence/presence of acute myocardial infarction. Logistic/Cox regression models were fitted to investigate the association between non-ischemic CS and patient characteristics, use of treatments and 30-day in-hospital mortality. Results: A total of 978 patients were enrolled in this study; median age was 70 (interquartile range 58, 79) years and 70% were male. Of these, 505 patients (52%) had non-ischemic CS. Patients with non-ischemic CS were more likely to be younger and female; were less likely to be active smokers, to have diabetes or decreased renal function, but more likely to have a history of myocardial infarction; and they were more likely to present with unfavorable hemodynamics and with mechanical ventilation. Regarding treatments, patients with non-ischemic CS were more likely to be treated with catecholamines, but less likely to be treated with extracorporeal membrane oxygenation or percutaneous left-ventricular assist devices. After adjustment for multiple relevant confounders, non-ischemic CS was associated with a significant increase in the risk of 30-day in-hospital mortality (hazard ratio 1.14, 95% confidence interval 1.04-1.24, p < 0.01). Conclusion: In this large study, non-ischemic CS accounted for more than 50% of all CS cases. Non-ischemic CS was not only associated with relevant differences in patient characteristics and use of treatments, but also with a worse prognosis. These findings highlight the need for effective treatment strategies for patients with non-ischemic CS.

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“…Um endgültig das Nutzen-Risiko-Profil abschätzen zu können, werden die Daten der randomisierten DanGer SHOCK-Studie dringend erwartet (NCT01633502) [60].…”

Section: Perkutane Systeme Ohne Oxygenierung/decarboxylierungunclassified