Influence of age and shock severity on short-term survival in patients with cardiogenic shock

Abstract

Aims Cardiogenic shock (CS) is associated with poor outcomes in older patients, but it remains unclear if this is due to higher shock severity. We sought to determine the associations between age and shock severity on mortality among patients with CS. Methods and results Patients with a diagnosis of CS from Mayo Clinic (2007–15) and University Clinic Hamburg (2009–17) were subdivided by age. Shock severity was graded using the Society for Cardiovascular Angiography and Intervention (SCAI) shock stages. Predictors of 30-day survival were determined using Cox proportional-hazards analysis. We included 1749 patients (934 from Mayo Clinic and 815 from University Clinic Hamburg), with a mean age of 67.6 ± 14.6 years, including 33.6% females. Acute coronary syndrome was the cause of CS in 54.0%. The distribution of SCAI shock stages was 24.1%; C, 28.0%; D, 33.2%; and E, 14.8%. Older patients had similar overall shock severity, more co-morbidities, worse kidney function, and decreased use of mechanical circulatory support compared to younger patients. Overall 30-day survival was 53.3% and progressively decreased as age or SCAI shock stage increased, with a clear gradient towards lower 30-day survival as a function of increasing age and SCAI shock stage. Progressively older age groups had incrementally lower adjusted 30-day survival than patients aged <50 years. Conclusion Older patients with CS have lower short-term survival, despite similar shock severity, with a high risk of death in older patients with more severe shock. Further research is needed to determine the optimal treatment strategies for older CS patients.

Impact of Age on Outcomes in Patients With Cardiogenic Shock

“…Moreover, the majority of published analyses have focused on CS from AMI. A recent 2 center study reported congruent findings of graded relationship between older age and lower survival in CS that was additive to the level of shock severity (16). Although CS was identified using a diagnosis code and a large percentage of patients were in early, stage B shock, our findings strengthen their observation that age and increasing shock severity are associated with worse outcomes.…”

“…With the introduction of the Society for Cardiovascular Angiography and Intervention (SCAI) CS stages, patients can now be classified consistently based on their severity of shock (14,15). Recent reports have noted that older patients with CS have lower short-term survival, despite similar shock severity (16). We sought to describe the relationships between age, SCAI stage, use of temporary MCS and mortality risk in patients with CS included in the Cardiogenic Shock Work Group (CSWG).…”

Shock Severity Assessment in Cardiac Intensive Care Unit Patients With Sepsis and Mixed Septic-Cardiogenic Shock

“… 5 , 6 Shock severity can be quantified using the Sequential Organ Failure Assessment (SOFA) cardiovascular subscore 5 , 7 , 8 or the Society for Cardiovascular Angiography and Interventions (SCAI) shock classification. 4 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 The SCAI shock classification was developed to grade the severity of CS, and unlike the SOFA cardiovascular subscore that was developed for sepsis, the SCAI shock classification incorporates the clinical trajectory and response to therapy. 7 , 16 The SCAI shock classification provides consistent mortality risk stratification in critically ill patients with underlying acute cardiac disease, including CICU patients and patients with CS.…”

Eligibility for mechanical circulatory support devices based on current and past randomised cardiogenic shock trials

“…based on clinical criteria only). 14,18,19 Enrolment of patients with beginning CS is a sensible choice for randomised CS trials testing an intervention with a lower risk profile. As an example, the lactate criterion was not obligatory in IABP-SHOCK II, so that the application of the IABP was also tested in patients with beginning CS.…”