Tendencias en el tratamiento del shock cardiogénico e impacto pronóstico del tipo de centros tratantes

Sánchez‐Salado, José Carlos; Burgos, Virginia; Arizá-Solé, Albert; Sionís, Alessandro; Canteli, A.; Bernal, José Luís; Fernández, Cristina; Castrillo, Cristina; Ruíz-Lera, Marta; López-de-Sá, Esteban; Lidón, Rosa María; Worner, Fernando; Martínez‐Sellés, Manuel; Segovia, Javier; Viana-Tejedor, Ana; Lorente, Victòria; Alegre, Oriol; Llaó, Isaac; González‐Costello, José; Manito, Nicolás; Cequier, Ángel; Bueno, Héctor; Elola, Javier

doi:10.1016/j.recesp.2019.10.009

Cited by 34 publications

(4 citation statements)

References 24 publications

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“…However they included patients with different profile, with only a 12% of ACS patients and 26% of patients being admitted to a non-university hospital. The admission in a tertiary hospital with specialized ICCU has been shown as an independent predictor of lower in-hospital mortality in a recent STEMI CS Spanish registry (22) and the allocation of patients to such centers has been widely recommended (23). In- hospital mortality in the ECMO-CS study was 50% (18), also higher than in our registry, although this trial only included ECMO candidates with refractory CS, limiting direct comparison with other CS registries.…”

Section: Discussionmentioning

confidence: 99%

Cardiogenic Shock Mortality According to Aetiology in a Mediterranean Cohort: Results From the Shock-Cat Study

García-García,

López-Sobrino,

Sanz-Girgas

et al. 2024

Preprint

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Background and objectivesMortality in cardiogenic shock (CS) remains elevated, with the potential for CS causes to impact prognosis and risk stratification. The aim was to investigate in-hospital prognosis and mortality in CS patients according to aetiology. We also assessed the prognostic accuracy of CardShock and IABP-SHOCK II scores.MethodsShock-CAT study was a multicentre, prospective, observational study conducted from December 2018-November 2019 in eight University hospitals in Catalonia, including non-selected consecutive CS patients. Data on clinical presentation, management, including mechanical circulatory support (MCS) were analysed comparing acute myocardial infarction (AMI) related CS and non-AMI-CS. The accuracy of CardShock and IABP-SHOCK II scores to assess 90-days mortality risk were also compared.ResultsA total of 382 CS patients were included, age 65.3 (SD 13.9) years, 75.1% men. Patients were classified as AMI-CS (n=232, 60.7%) and non-AMI-CS (n=150, 39.3%). In the AMI-CS group, 77.6% were STEMI. Main aetiologies for non-AMI-CS were heart failure (36.2%), arrhythmias (22.1%) and valve disease (8.0%). AMI-CS patients required more MCS than non-AMI-CS (43.1% vs 16.7%, p<0.001). In-hospital mortality was higher in AMI-CS (37.1 vs 26.7%, p=0.035), with a two-fold increased risk after multivariate adjustment (OR 2.24, p=0.019). The IABP-SHOCK II had superior discrimination for predicting 90-days mortality when compared with CardShock in AMI-CS patients (AUC 0.74 vs 0.66, p=0.047) although both scores performed similarly in non-AMI-CS (AUC 0.64 vs 0.62, p=0.693).ConclusionsIn our cohort, AMI-CS mortality was increased by two-fold when compared to non- AMI-CS. IABP-SHOCK II score provides better 90-days mortality risk prediction than CardShock score in AMI-CS, but both scores performed similar in non-AMI-CS patients.

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Section: Discussionmentioning

confidence: 99%

Cardiogenic Shock Mortality According to Aetiology in a Mediterranean Cohort: Results From the Shock-Cat Study

García-García,

López-Sobrino,

Sanz-Girgas

et al. 2024

Preprint

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“…This value is higher than those reported in the French registry (63%) in 2005 [5] and similar to those from the Italian study (83%) [10] in 2014. Both coronary revascularization procedures and the availability of an intensive cardiac care unit have been associated with lower mortality rates [8], although benefits in survival with the use of hemodynamic support devices (i.e., an intra-aortic balloon pump [11] or Impella support [20,21]) are as yet inconclusive. Furthermore, despite proper reperfusion, no differences in mechanical complications or ventricular arrhythmias were observed over the last 30 years.…”

Section: Stemi-cs 30-day and 1-year Mortality Trendsmentioning

confidence: 99%

“…Data on long-term trends in STEMI-CS prevalence and short-and long-term mortality are scarce. Indeed, most of the reported data reflect either limited trends, rarely beyond a decade, or only in-hospital or short-term evolution [8,9]. Accordingly, the aim of this study was to describe trends in prevalence, management, in-hospital complications, and 30-day and 1-year mortality in STEMI-CS over the last three decades .…”

Section: Introductionmentioning

confidence: 99%

“…CS is the leading cause of hospital mortality associated with acute myocardial infarction (MI). Prevalence of CS due to acute MI varies from 5 to 15% [1][2][3][4][5][6][7][8], although some of these data come from studies performed before the generalization of reperfusion [1,2]. Despite recent advances in the prevention and management of acute MI, and the widespread use of primary percutaneous coronary intervention in patients with ST-elevation MI (STEMI), acute phase mortality of STEMI-complicated CS (STEMI-CS) remains unacceptably high [6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Short- and Long-Term Mortality Trends in STEMI-Cardiogenic Shock over Three Decades (1989–2018): The Ruti-STEMI-Shock Registry

García-García

Oliveras

Ouaddi

et al. 2020

JCM

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Aims: Cardiogenic shock (CS) is an ominous complication of ST-elevation myocardial infarction (STEMI), despite the recent widespread use of reperfusion and invasive management. The Ruti-STEMI-Shock registry analysed the prevalence of and 30-day and 1-year mortality rates in ST-elevation myocardial infarction (STEMI) complicated by CS (STEMI-CS) over the last three decades. Methods and Results: From February 1989 to December 2018, 493 STEMI-CS patients were consecutively admitted in a well-defined geographical area of ~850,000 inhabitants. Patients were classified into six five-year periods based on their year of admission. STEMI-CS mortality trends were analysed at 30 days and 1 year across the six strata. Cox regression analyses were performed for comparisons. Mean age was 67.5 ± 11.7 years; 69.4% were men. STEMI-CS prevalence did not decline from period 1 to 6 (7.1 vs. 6.2%, p = 0.218). Reperfusion therapy increased from 22.5% in 1989–1993 to 85.4% in 2014–2018. Thirty-day all-cause mortality declined from period 1 to 6 (65% vs. 50.5%, p < 0.001), with a 9% reduction after multivariable adjustment (HR: 0.91; 95% CI: 0.84–0.99; p = 0.024). One-year all-cause mortality declined from period 1 to 6 (67.5% vs. 57.3%, p = 0.001), with an 8% reduction after multivariable adjustment (HR: 0.92; 95% CI: 0.85–0.99; p = 0.030). Short- and long-term mortality trends in patients aged ≥ 75 years remained ~75%. Conclusions: Short- and long-term STEMI-CS-related mortality declined over the last 30 years, to ~50% of all patients. We have failed to achieve any mortality benefit in STEMI-CS patients over 75 years of age.

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Cardiogenic shock mortality according to Aetiology in a Mediterranean cohort: Results from the Shock‐CAT study

García‐García,

López‐Sobrino,

Sanz‐Girgas

et al. 2024

ESC Heart Failure

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AimsMortality in cardiogenic shock (CS) remains elevated, with the potential for CS causes to impact prognosis and risk stratification. The aim was to investigate in‐hospital prognosis and mortality in CS patients according to aetiology. We also assessed the prognostic accuracy of CardShock and IABP‐SHOCK II scores.MethodsShock‐CAT study was a multicentre, prospective, observational study conducted from December 2018 to November 2019 in eight university hospitals in Catalonia, including non‐selected consecutive CS patients. Data on clinical presentation, management, including mechanical circulatory support (MCS) were analysed comparing acute myocardial infarction (AMI) related CS and non‐AMI‐CS. The accuracy of CardShock and IABP‐SHOCK II scores to assess 90 day mortality risk were also compared.ResultsA total of 382 CS patients were included, age 65.3 (SD 13.9) years, 75.1% men. Patients were classified as AMI‐CS (n = 232, 60.7%) and non‐AMI‐CS (n = 150, 39.3%). In the AMI‐CS group, 77.6% were STEMI. Main aetiologies for non‐AMI‐CS were heart failure (36.2%), arrhythmias (22.1%) and valve disease (8.0%). AMI‐CS patients required more MCS than non‐AMI‐CS (43.1% vs. 16.7%, P < 0.001). In‐hospital mortality was higher in AMI‐CS (37.1 vs. 26.7%, P = 0.035), with a two‐fold increased risk after multivariate adjustment (odds ratio 2.24, P = 0.019). The IABP‐SHOCK II had superior discrimination for predicting 90 day mortality when compared with CardShock in AMI‐CS patients [area under the curve (AUC) 0.74 vs. 0.66, P = 0.047] although both scores performed similarly in non‐AMI‐CS (AUC 0.64 vs. 0.62, P = 0.693).ConclusionsIn our cohort, AMI‐CS mortality was increased by two‐fold when compared with non‐AMI‐CS. IABP‐SHOCK II score provides better 90 day mortality risk prediction than CardShock score in AMI‐CS, but both scores performed similar in non‐AMI‐CS patients.

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Tendencias en el tratamiento del shock cardiogénico e impacto pronóstico del tipo de centros tratantes

Cited by 34 publications

References 24 publications

Cardiogenic Shock Mortality According to Aetiology in a Mediterranean Cohort: Results From the Shock-Cat Study

Cardiogenic Shock Mortality According to Aetiology in a Mediterranean Cohort: Results From the Shock-Cat Study

Short- and Long-Term Mortality Trends in STEMI-Cardiogenic Shock over Three Decades (1989–2018): The Ruti-STEMI-Shock Registry

Cardiogenic shock mortality according to Aetiology in a Mediterranean cohort: Results from the Shock‐CAT study

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