Clinical picture and risk prediction of short-term mortality in cardiogenic shock

Veli-Pekka Harjola; Johan Lassus; Alessandro Sionis; Lars Køber; Tuukka Tarvasmäki; Jindrich Spinar; John Parissis; Marek Banaszewski; Jose Silva-Cardoso; Valentina Carubelli; Salvatore Di Somma; Heli Tolppanen; Uwe Zeymer; Holger Thiele; Markku S Nieminen; Alexandre Mebazaa; CardShock Study Investigators

doi:10.1002/ejhf.260

Clinical picture and risk prediction of short-term mortality in cardiogenic shock

Veli-Pekka Harjola, Johan Lassus, Alessandro Sionis, Lars Køber, Tuukka Tarvasmäki, Jindrich Spinar, John Parissis, Marek Banaszewski, Jose Silva-Cardoso, Valentina Carubelli, Salvatore Di Somma, Heli Tolppanen, Uwe Zeymer, Holger Thiele, Markku S Nieminen, Alexandre Mebazaa, CardShock Study Investigators

Institut for Klinisk Medicin

232 Citationer (Scopus)

Abstract

AIMS: The aim of this study was to investigate the clinical picture and outcome of cardiogenic shock and to develop a risk prediction score for short-term mortality.

METHODS AND RESULTS: The CardShock study was a multicentre, prospective, observational study conducted between 2010 and 2012. Patients with either acute coronary syndrome (ACS) or non-ACS aetiologies were enrolled within 6 h from detection of cardiogenic shock defined as severe hypotension with clinical signs of hypoperfusion and/or serum lactate >2 mmol/L despite fluid resuscitation (n = 219, mean age 67, 74% men). Data on clinical presentation, management, and biochemical variables were compared between different aetiologies of shock. Systolic blood pressure was on average 78 mmHg (standard deviation 14 mmHg) and mean arterial pressure 57 (11) mmHg. The most common cause (81%) was ACS (68% ST-elevation myocardial infarction and 8% mechanical complications); 94% underwent coronary angiography, of which 89% PCI. Main non-ACS aetiologies were severe chronic heart failure and valvular causes. In-hospital mortality was 37% (n = 80). ACS aetiology, age, previous myocardial infarction, prior coronary artery bypass, confusion, low LVEF, and blood lactate levels were independently associated with increased mortality. The CardShock risk Score including these variables and estimated glomerular filtration rate predicted in-hospital mortality well (area under the curve 0.85).

CONCLUSION: Although most commonly due to ACS, other causes account for one-fifth of cases with shock. ACS is independently associated with in-hospital mortality. The CardShock risk Score, consisting of seven common variables, easily stratifies risk of short-term mortality. It might facilitate early decision-making in intensive care or guide patient selection in clinical trials.

TRIAL REGISTRATION: NCT01374867.

Originalsprog	Engelsk
Tidsskrift	European Journal of Heart Failure
Vol/bind	17
Udgave nummer	5
Sider (fra-til)	501-9
Antal sider	9
ISSN	1388-9842
DOI	https://doi.org/10.1002/ejhf.260
Status	Udgivet - 1 maj 2015

Adgang til dokumentet

10.1002/ejhf.260

ejhf.260Forlagets udgivne version, 248 KB

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/ejhf.260

Citationsformater

Harjola, V-P., Lassus, J., Sionis, A., Køber, L., Tarvasmäki, T., Spinar, J., Parissis, J., Banaszewski, M., Silva-Cardoso, J., Carubelli, V., Di Somma, S., Tolppanen, H., Zeymer, U., Thiele, H., Nieminen, M. S., Mebazaa, A., & CardShock Study Investigators (2015). Clinical picture and risk prediction of short-term mortality in cardiogenic shock. European Journal of Heart Failure, 17(5), 501-9. https://doi.org/10.1002/ejhf.260

Harjola, V-P, Lassus, J, Sionis, A, Køber, L, Tarvasmäki, T, Spinar, J, Parissis, J, Banaszewski, M, Silva-Cardoso, J, Carubelli, V, Di Somma, S, Tolppanen, H, Zeymer, U, Thiele, H, Nieminen, MS, Mebazaa, A & CardShock Study Investigators 2015, 'Clinical picture and risk prediction of short-term mortality in cardiogenic shock', European Journal of Heart Failure, bind 17, nr. 5, s. 501-9. https://doi.org/10.1002/ejhf.260

@article{e85f1d6ec798403da20ca446da956ba4,

title = "Clinical picture and risk prediction of short-term mortality in cardiogenic shock",

abstract = "AIMS: The aim of this study was to investigate the clinical picture and outcome of cardiogenic shock and to develop a risk prediction score for short-term mortality.METHODS AND RESULTS: The CardShock study was a multicentre, prospective, observational study conducted between 2010 and 2012. Patients with either acute coronary syndrome (ACS) or non-ACS aetiologies were enrolled within 6 h from detection of cardiogenic shock defined as severe hypotension with clinical signs of hypoperfusion and/or serum lactate >2 mmol/L despite fluid resuscitation (n = 219, mean age 67, 74% men). Data on clinical presentation, management, and biochemical variables were compared between different aetiologies of shock. Systolic blood pressure was on average 78 mmHg (standard deviation 14 mmHg) and mean arterial pressure 57 (11) mmHg. The most common cause (81%) was ACS (68% ST-elevation myocardial infarction and 8% mechanical complications); 94% underwent coronary angiography, of which 89% PCI. Main non-ACS aetiologies were severe chronic heart failure and valvular causes. In-hospital mortality was 37% (n = 80). ACS aetiology, age, previous myocardial infarction, prior coronary artery bypass, confusion, low LVEF, and blood lactate levels were independently associated with increased mortality. The CardShock risk Score including these variables and estimated glomerular filtration rate predicted in-hospital mortality well (area under the curve 0.85).CONCLUSION: Although most commonly due to ACS, other causes account for one-fifth of cases with shock. ACS is independently associated with in-hospital mortality. The CardShock risk Score, consisting of seven common variables, easily stratifies risk of short-term mortality. It might facilitate early decision-making in intensive care or guide patient selection in clinical trials.TRIAL REGISTRATION: NCT01374867.",

keywords = "Acute Coronary Syndrome, Aged, Coronary Angiography, Female, Heart Failure, Heart Valve Diseases, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Shock, Cardiogenic",

author = "Veli-Pekka Harjola and Johan Lassus and Alessandro Sionis and Lars K{\o}ber and Tuukka Tarvasm{\"a}ki and Jindrich Spinar and John Parissis and Marek Banaszewski and Jose Silva-Cardoso and Valentina Carubelli and {Di Somma}, Salvatore and Heli Tolppanen and Uwe Zeymer and Holger Thiele and Nieminen, {Markku S} and Alexandre Mebazaa and {CardShock Study Investigators}",

note = "{\textcopyright} 2015 The Authors. European Journal of Heart Failure {\textcopyright} 2015 European Society of Cardiology.",

year = "2015",

month = may,

day = "1",

doi = "10.1002/ejhf.260",

language = "English",

volume = "17",

pages = "501--9",

journal = "European Journal of Heart Failure, Supplement",

issn = "1567-4215",

publisher = "JohnWiley & Sons Ltd",

number = "5",

}

TY - JOUR

T1 - Clinical picture and risk prediction of short-term mortality in cardiogenic shock

AU - Harjola, Veli-Pekka

AU - Lassus, Johan

AU - Sionis, Alessandro

AU - Køber, Lars

AU - Tarvasmäki, Tuukka

AU - Spinar, Jindrich

AU - Parissis, John

AU - Banaszewski, Marek

AU - Silva-Cardoso, Jose

AU - Carubelli, Valentina

AU - Di Somma, Salvatore

AU - Tolppanen, Heli

AU - Zeymer, Uwe

AU - Thiele, Holger

AU - Nieminen, Markku S

AU - Mebazaa, Alexandre

AU - CardShock Study Investigators

PY - 2015/5/1

Y1 - 2015/5/1

N2 - AIMS: The aim of this study was to investigate the clinical picture and outcome of cardiogenic shock and to develop a risk prediction score for short-term mortality.METHODS AND RESULTS: The CardShock study was a multicentre, prospective, observational study conducted between 2010 and 2012. Patients with either acute coronary syndrome (ACS) or non-ACS aetiologies were enrolled within 6 h from detection of cardiogenic shock defined as severe hypotension with clinical signs of hypoperfusion and/or serum lactate >2 mmol/L despite fluid resuscitation (n = 219, mean age 67, 74% men). Data on clinical presentation, management, and biochemical variables were compared between different aetiologies of shock. Systolic blood pressure was on average 78 mmHg (standard deviation 14 mmHg) and mean arterial pressure 57 (11) mmHg. The most common cause (81%) was ACS (68% ST-elevation myocardial infarction and 8% mechanical complications); 94% underwent coronary angiography, of which 89% PCI. Main non-ACS aetiologies were severe chronic heart failure and valvular causes. In-hospital mortality was 37% (n = 80). ACS aetiology, age, previous myocardial infarction, prior coronary artery bypass, confusion, low LVEF, and blood lactate levels were independently associated with increased mortality. The CardShock risk Score including these variables and estimated glomerular filtration rate predicted in-hospital mortality well (area under the curve 0.85).CONCLUSION: Although most commonly due to ACS, other causes account for one-fifth of cases with shock. ACS is independently associated with in-hospital mortality. The CardShock risk Score, consisting of seven common variables, easily stratifies risk of short-term mortality. It might facilitate early decision-making in intensive care or guide patient selection in clinical trials.TRIAL REGISTRATION: NCT01374867.

AB - AIMS: The aim of this study was to investigate the clinical picture and outcome of cardiogenic shock and to develop a risk prediction score for short-term mortality.METHODS AND RESULTS: The CardShock study was a multicentre, prospective, observational study conducted between 2010 and 2012. Patients with either acute coronary syndrome (ACS) or non-ACS aetiologies were enrolled within 6 h from detection of cardiogenic shock defined as severe hypotension with clinical signs of hypoperfusion and/or serum lactate >2 mmol/L despite fluid resuscitation (n = 219, mean age 67, 74% men). Data on clinical presentation, management, and biochemical variables were compared between different aetiologies of shock. Systolic blood pressure was on average 78 mmHg (standard deviation 14 mmHg) and mean arterial pressure 57 (11) mmHg. The most common cause (81%) was ACS (68% ST-elevation myocardial infarction and 8% mechanical complications); 94% underwent coronary angiography, of which 89% PCI. Main non-ACS aetiologies were severe chronic heart failure and valvular causes. In-hospital mortality was 37% (n = 80). ACS aetiology, age, previous myocardial infarction, prior coronary artery bypass, confusion, low LVEF, and blood lactate levels were independently associated with increased mortality. The CardShock risk Score including these variables and estimated glomerular filtration rate predicted in-hospital mortality well (area under the curve 0.85).CONCLUSION: Although most commonly due to ACS, other causes account for one-fifth of cases with shock. ACS is independently associated with in-hospital mortality. The CardShock risk Score, consisting of seven common variables, easily stratifies risk of short-term mortality. It might facilitate early decision-making in intensive care or guide patient selection in clinical trials.TRIAL REGISTRATION: NCT01374867.

KW - Acute Coronary Syndrome

KW - Aged

KW - Coronary Angiography

KW - Female

KW - Heart Failure

KW - Heart Valve Diseases

KW - Humans

KW - Male

KW - Middle Aged

KW - Prospective Studies

KW - Risk Factors

KW - Shock, Cardiogenic

U2 - 10.1002/ejhf.260

DO - 10.1002/ejhf.260

M3 - Journal article

C2 - 25820680

SN - 1567-4215

VL - 17

SP - 501

EP - 509

JO - European Journal of Heart Failure, Supplement

JF - European Journal of Heart Failure, Supplement

IS - 5

ER -

Clinical picture and risk prediction of short-term mortality in cardiogenic shock

Abstract

Adgang til dokumentet

Fingeraftryk

Citationsformater