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. 2021 Aug 1;49(8):1293-1302.
doi: 10.1097/CCM.0000000000004948.

The Range of Cardiogenic Shock Survival by Clinical Stage: Data From the Critical Care Cardiology Trials Network Registry

Patrick R Lawler  1   2   3   4   5   6   7   8   9   10   11   12   13   14   15   16 , David D Berg  4 , Jeong-Gun Park  4 , Jason N Katz  5 , Vivian M Baird-Zars  4 , Gregory W Barsness  6 , Erin A Bohula  4 , Anthony P Carnicelli  7 , Sunit-Preet Chaudhry  8 , Jacob C Jentzer  6   9 , Venu Menon  10 , Thomas Metkus  11 , Jose Nativi-Nicolau  12 , Nicholas Phreaner  13 , Shashank S Sinha  14 , Jeffrey J Teuteberg  15 , Sean van Diepen  16 , David A Morrow  4 ; Critical Care Cardiology Trials Network Investigators
Affiliations

The Range of Cardiogenic Shock Survival by Clinical Stage: Data From the Critical Care Cardiology Trials Network Registry

Patrick R Lawler et al. Crit Care Med. .

Abstract

Objectives: Cardiogenic shock presents with variable severity. Categorizing cardiogenic shock into clinical stages may improve risk stratification and patient selection for therapies. We sought to determine whether a structured implementation of the 2019 Society for Cardiovascular Angiography and Interventions clinical cardiogenic shock staging criteria that is ascertainable in clinical registries discriminates mortality in a contemporary population with or at-risk for cardiogenic shock.

Design: We developed a pragmatic application of the Society for Cardiovascular Angiography and Interventions cardiogenic shock staging criteria-A (at-risk), B (beginning), C (classic cardiogenic shock), D (deteriorating), or E (extremis)-and examined outcomes by stage.

Setting: The Critical Care Cardiology Trials Network is an investigator-initiated multicenter research collaboration coordinated by the TIMI Study Group (Boston, MA). Consecutive admissions with or at-risk for cardiogenic shock during two annual 2-month collection periods (2017-2019) were analyzed.

Patients: Patients with or at-risk for cardiogenic shock.

Measurements and main results: Of 8,240 CICU admissions reviewed, 1,991 (24%) had or were at-risk for cardiogenic shock. Distributions across the five stages were as follows: A: 33%; B: 7%; C: 16%; D: 23%; and E: 21%. Overall in-hospital mortality among patients with established cardiogenic shock was 39%; however, mortality varied from only 15.8% to 32.1% to 62.5% across stages C, D, and E (Cochran-Armitage ptrend < 0.0001). The Society for Cardiovascular Angiography and Interventions stages improved mortality prediction beyond the Sequential Organ Failure Assessment and Intra-Aortic Balloon Pumpin Cardiogenic Shock II scores.

Conclusions: Although overall mortality in cardiogenic shock remains high, it varies considerably based on clinical stage, identifying stage C as relatively lower risk. We demonstrate a pragmatic adaptation of the Society for Cardiovascular Angiography and Interventions cardiogenic shock stages that effectively stratifies mortality risk and could be leveraged for future clinical research.

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Conflict of interest statement

Dr. Katz received funding from Abbott Corporation. Dr. Carnicelli received grant funding from the National Institutes of Health (NIH), and he received support for article research from the NIH. Dr. Metkus received funding from TelaDoc-Best Doctors, Oakstone-EBIX, and McGraw-Hill Publishing, and he received support for article research from the NIH. Dr. Nativi-Nicolau received funding from Alnylam Pharmaceuticals, Akcea Therapeutics, Pfizer Inc, and Eidos Therapeutics. Dr. Sinha received funding from the Abiomed Critical Care Advisory Board. Dr. Teuteberg received funding from Abbott, Abiomed, Medtronic, and CareDx Paragonix. The remaining authors have disclosed that they have no potential conflicts of interest.

References

    1. van Diepen S, Katz JN, Albert NM, et al.; American Heart Association Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research; and Mission: Lifeline. Contemporary management of cardiogenic shock: A scientific statement from the American Heart Association. Circulation. 2017; 136:e232–e268
    1. Kolte D, Khera S, Aronow WS, et al. Trends in incidence, management, and outcomes of cardiogenic shock complicating ST-elevation myocardial infarction in the United States. J Am Heart Assoc. 2014; 3:e000590
    1. Wayangankar SA, Bangalore S, McCoy LA, et al. Temporal trends and outcomes of patients undergoing percutaneous coronary interventions for cardiogenic shock in the setting of acute myocardial infarction: A report from the CathPCI registry. JACC Cardiovasc Interv. 2016; 9:341–351
    1. Goldberg RJ, Spencer FA, Gore JM, et al. Thirty-year trends (1975 to 2005) in the magnitude of, management of, and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: a population-based perspective. Circulation. 2009; 119:1211–1219
    1. Thiele H, Akin I, Sandri M, et al.; CULPRIT-SHOCK Investigators. PCI strategies in patients with acute myocardial infarction and cardiogenic shock. N Engl J Med. 2017; 377:2419–2432

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