Cardiogenic Shock Classification to Predict Mortality in the Cardiac Intensive Care Unit

Jentzer, Jacob C.; Diepen, Sean van; Barsness, Gregory W.; Henry, Timothy D.; Menon, Venu; Rihal, Charanjit S.; Naidu, Srihari S.; Baran, David A.

doi:10.1016/j.jacc.2019.07.077

Cited by 324 publications

(346 citation statements)

References 25 publications

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“…Stroke was referred to as central nervous system injury caused by an ischemic or hemorrhagic event, and was verified by neuropathological examination (NIHSS) and neuroimaging (computed tomography or magnetic resonance imaging) . Cardiogenic shock was defined as the cardiac disorder that resulted in both clinical and biochemical evidence of tissue hypoperfusion . Major bleeding was defined as Bleeding Academic Research Consortium type ≥ 3 bleeding…”

Section: Methodsmentioning

confidence: 99%

Platelet function testing guided antiplatelet therapy reduces cardiovascular events in Chinese patients with ST‐segment elevation myocardial infarction undergoing percutaneous coronary intervention: The PATROL study

You

Guo

et al. 2020

Cathet Cardio Intervent

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Background Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor has become the standard of care to reduce thrombotic events in patients with acute coronary syndrome or after percutaneous coronary intervention (PCI). The role of routine platelet function testing (PFT) in patients treated with DAPT after PCI remains controversial and evidence of PFT‐guided antiplatelet therapy for patients with ST‐segment elevation myocardial infarction (STEMI) undergoing primary PCI is limited. Methods We analyzed 1,353 consecutive STEMI patients undergoing primary PCI. PFT was performed 72 hr postprocedure using a vasodilator‐stimulated phosphoprotein assay. The primary endpoint of major adverse cardio‐cerebral events (MACCEs) was defined as a composite of all‐cause death, cardiac death, nonfatal myocardial infarction, target vessel revascularization, and ischemic stroke. Patients with high platelet reactivity (HPR) were randomized to receive an intensified antiplatelet strategy by switching from clopidogrel to ticagrelor (HPR switch group) or to continue on clopidogrel (HPR nonswitch group). One‐year clinical outcomes were compared among the groups. Results The baseline clinical characteristics were comparable across all groups (all p > .05). At the 1‐year clinical follow‐up, the primary endpoint of MACCE was significantly higher in the HPR nonswitch group than in the non‐HPR and HPR switch groups (19.49% vs. 10.20% or 8.57%, p < .05), which was mainly caused by higher mortality (14.87% vs. 4.51% or 5.71%, p < .05). Major bleeding events were comparable across the groups. Conclusions In STEMI patients with HPR, identified by vasodilator stimulated phosphoprotein (VASP)‐determined PFT, switching clopidogrel to ticagrelor could significantly improve 1‐year clinical outcomes without increasing the risk of bleeding.

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Section: Methodsmentioning

confidence: 99%

Platelet function testing guided antiplatelet therapy reduces cardiovascular events in Chinese patients with ST‐segment elevation myocardial infarction undergoing percutaneous coronary intervention: The PATROL study

You

Guo

et al. 2020

Cathet Cardio Intervent

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“…On top of "classic CS", "deteriorating CS" and "in extremis CS", this classification importantly adds definitions for patients "at risk of CS" and with "beginning CS". Application of this classification in clinical practice might improve early recognition of CS and could guide use of treatments, e.g., earlier initiation in patients with beginning CS or more invasive treatments in patients with more advanced CS [9,10]. Additionally, the utilization of "CS teams" seems to be promising to improve outcomes in non-ischemic CS.…”

Section: Differences In Patient Characteristics Between Non-ischemic mentioning

confidence: 99%

“…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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“…13 Increased hospital mortality has been demonstrated for patients in more advanced stages of shock as assessed by this classification. 21,22 On the basis of our selected definition for CS, all patients included would be categorized as "classic" (Stage C) or worse under the SCAI classification. Patients "at risk" (Stage A) or "beginning" (Stage B) would not have fulfilled CS criteria and activation of our Code Shock protocol.…”

Section: Discussionmentioning

confidence: 99%

“…The treatment group had a significantly lower proportion of patients with ischemic cardiomyopathy (8% vs 31%) and a higher proportion with acute myocarditis (14% vs 0%). Median left ventricular ejection fraction was 20% (IQR, [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27], and 58% of patients had moderate to severe right ventricular dysfunction. Serum lactate was elevated, but there were no significant differences in baseline or peak levels between treatment and control groups.…”

Section: Patient Characteristicsmentioning

confidence: 99%

Multidisciplinary Code Shock Team in Cardiogenic Shock: A Canadian Centre Experience

et al. 2020

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Background: Cardiogenic shock (CS) is associated with high mortality. We report on a "Shock Team" approach of combined interdisciplinary expertise for decision making, expedited assessment, and treatment. Methods: We reviewed 100 patients admitted in CS over 52 months. Patients managed under a Code Shock Team protocol (n ¼ 64, treatment) from 2016 to 2019 were compared with standard care (n ¼ 36, control) from 2015 to 2016. The cohort was predominantly male (78% treatment, 67% control) with a median age of 55 years (interquartile range [IQR], 43-64) for treatment vs 64 years (IQR, 48-69) for control (P ¼ 0.01). New heart failure was more common in the treatment group: 61% vs 36%, P ¼ 0.02. Acute myocardial infarction comprised 13% of patients in CS. There were no significant differences between treatment and control in markers of clinical acuity, including median left ventricular ejection fraction (18% vs 20%), prevalence of R ESUM E Contexte : Le choc cardiog enique (CC) est associ e à une mortalit e elev ee. Nous d ecrivons une approche où la prise de d ecision, l' evaluation rapide des cas et le traitement sont confi es à une « equipe de choc » interdisciplinaire. M ethodologie : Nous avons examin e les cas de 100 patients hospitalis es en raison d'un CC sur une p eriode de 52 mois. Les patients pris en charge par une equipe interdisciplinaire selon un protocole d'intervention d eclench e par un code-choc (n ¼ 64, groupe trait e) de 2016 à 2019 ont et e compar es à des patients ayant reçu des soins courants (n ¼ 36, groupe t emoin) de 2015 à 2016. Les patients de la cohorte etaient majoritairement de sexe masculin (78 % dans le groupe trait e, 67 % dans le groupe t emoin) et l'âge m edian etait de 55 ans (intervalle interquartile [IIQ]: 43-64) au sein du groupe trait e par rapport à 64 ans (IIQ : 48-69) au sein du groupe t emoin (p ¼ 0,01). Les nou-Cardiogenic shock (CS) is defined as a low cardiac output state with end-organ hypoperfusion. 1 The etiology is broad and includes acute myocardial infarction (AMI), acute decompensated heart failure (ADHF) of preexisting cardiomyopathy, fulminant myocarditis, and tachyarrhythmia. 1 Clinical presentation is variable ranging from rapid hemodynamic deterioration over hours to a more insidious onset over days. Heterogeneity of etiology, presentation, and clinical trajectory have contributed to difficulties standardizing definitions for diagnosis, leading to delayed recognition, management variability, and uncertain optimal practice. Consequently, despite medical advances, clinical outcomes in CS remain poor with up to 50% in-hospital mortality reported in most series. 2,3 An increasing number of institutions are adopting a multidisciplinary team-based strategy for CS and have shown feasibility associated with improved outcomes. [4][5][6][7] In 2016, a Code Shock Team approach was implemented at our institution, which uses an emergent "Code" activation similar to other high-acuity, time-sensitive conditions such as ST-elevation myocardial infarction, cardiac arrest, and...

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Cardiogenic Shock Classification to Predict Mortality in the Cardiac Intensive Care Unit

Cited by 324 publications

References 25 publications

Platelet function testing guided antiplatelet therapy reduces cardiovascular events in Chinese patients with ST‐segment elevation myocardial infarction undergoing percutaneous coronary intervention: The PATROL study

Platelet function testing guided antiplatelet therapy reduces cardiovascular events in Chinese patients with ST‐segment elevation myocardial infarction undergoing percutaneous coronary intervention: The PATROL study

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

Multidisciplinary Code Shock Team in Cardiogenic Shock: A Canadian Centre Experience

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