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Garcia-Garcia C, Andrea R, Sanz E, Sanchez-Salado JC, Aboal J, Pastor P, Buera I, Sionis A, Lopez T, Perez-Rodriguez M, Ariza A, Baneras J, Tomas C, Cediel G, Rueda F. Mortality risk in cardiogenic shock depending on aetiology in a Mediterranean cohort. Prognostic accuracy of CardShock vs IABP score: the Shock CAT study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Mortality in cardiogenic shock (CS) remains very high. Several risk scores have been purposed to early stratification, although the CS aetiology could influence in this prediction.
Purpose
The aim is to investigate in-hospital prognosis and mortality risk in CS patients depending on the CS aetiology comparing the prognostic accuracy of CardShock and IABP scores in a Mediterranean cohort.
Method
Shock CAT study was a multicentre, prospective, observational study conducted between December 2018 and December 2019 in eight public University hospitals in Catalonia (Spain), including CS patients due to acute coronary syndrome (ACS) and other aetiologies. Data on clinical presentation, biomarkers, management, including mechanical assistance support were analyzed comparing ACS and non-ACS patients. Cardshock and IABP score have been compared to assess 90-days mortality risk in both groups.
Results
A total of 382 CS patients were included, mean age was 65.3 (SD 13.9) years and 75.1% were men. Patient were classified in ACS (n=232, 60.7%) and non-ACS (n=150, 39.3%). In ACS group, 77.6% were STEMI, reperfussion in 84.7% of cases, all with primary angioplasty, 9% developed mechanical complications and 19.4% primary ventricular fibrillation. Main non-ACS aetiologies were severe heart failure (36.2%), malignant arrhythmias (22.1%), valve disease (8.0%) and myocarditis (7.4%). ACS group had less prevalence of women (17.7% vs 36%, p=0.001) and previous myocardial infarction (13.9% vs 24.8%, p=0.007). Mechanical assistance device was implanted more in ACS patients (43.1% vs 16.7%, p<0.001, mainly intraaortic balloon pump (35.6% vs 9.8%, p<0.001) and ECMO (10.7% vs 3%, p=0.01). Both shock risk scores were higher in ACS patients, Cardshock (4.5 vs 4.0, p=0.006) and IABP (2.4 vs 1.9, p=0.005). In-hospital mortality was higher in ACS (37.1 vs 26.7%, p=0.035) although this difference loss the significance at 90-days (40.9 vs 31.8%, p=0.074) and 6-months (45.2 vs 35.8%, p=0.176). Receiver-operating characteristic curves demonstrated that IABP shock score had superior prognostic power for predicting 90-days mortality when compared with Cardshock score in ACS patients (area under the curve -AUC- 0.74 vs 0.66) respectively, p=0.047, although both scores were similar in non-ACS (AUC 0.64 vs 0.62, p=0.693), Figures 1–2.
Conclusions
Cardiogenic shock due to ACS had higher in-hospital mortality than non-ACS CS, although this difference decreased at 90 days and 6 months. IABP score provided better 90-days mortality risk prediction than CardShock score in ACS patients, but both scores are similar in non-ACS cardiogenic shock.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
| | - R Andrea
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - E Sanz
- University Hospital of Taragona Joan XXIII, Tarragona, Spain
| | | | - J Aboal
- University Hospital de Girona Dr. Josep Trueta, Regiό Sanitaria de Girona, Girona, Spain
| | - P Pastor
- Hospital Arnau de Vilanova, Lleida, Spain
| | - I Buera
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - A Sionis
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - T Lopez
- Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - A Ariza
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - J Baneras
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - C Tomas
- Hospital Arnau de Vilanova, Lleida, Spain
| | - G Cediel
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - F Rueda
- Germans Trias i Pujol University Hospital, Barcelona, Spain
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Garcia-Garcia C, Lopez T, Sanz E, Sanchez-Salado JC, Aboal J, Tomas C, Baneras J, Sionis A, Andrea R, Perez-Rodriguez M, Ariza A, Pastor P, Buera I, Cediel G, Rueda F. Mortality risk in cardiogenic shock: head to head comparision CardShock vs IABP score in a Mediterranean cohort: the Shock CAT study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Mortality in cardiogenic shock (CS) remains very high. Several risk scores have been purposed to early stratification.
Purpose
The aim is to investigate in-hospital prognosis and mortality risk in CS patients comparing the prognostic accuracy of CardShock and IABP scores in a Mediterranean cohort.
Method
Shock CAT study was a multicentre, prospective, observational study conducted between December 2018 and December 2019 in eight public University hospitals in Catalonia (Spain), including CS patients due to acute coronary syndrome (ACS) and other aetiologies. Data on clinical presentation, biomarkers, management, including mechanical assistance support were analyzed. Cardshock and IABP score have been compared to assess 90-days mortality risk in a Mediterranean cohort.
Results
A total of 382 CS patients were included, mean age was 65.3 (SD 13.9) years and 75.1% were men. The most common cause of CS was ACS (61%, n=233); of them, 77.6% were STEMI, 9% developed mechanical complications and 19.4% primary ventricular fibrillation. STEMI patients were reperfused in 84.7% of cases, all with primary angioplasty. Main non-ACS aetiologies were severe acute heart failure, malignant arrhythmias and myocarditis. Mechanical assistance device was implanted in one third of patients (n=119), mainly intraaortic balloon pump (26.1%), ECMO in 7.8% and Impella in 4.5%. Average Cardshock score was 4.3 (SD 1.74) and mean IABP score was 2.2 (SD 1.61). In-hospital mortality was 33% (126 patients) and 90-days mortality was 37.3% (141 patients). Receiver-operating characteristic curves demonstrated that IABP shock score had superior prognostic power for predicting 90-days mortality when compared with Cardshock score (area under the curve 0.72 vs 0.66) respectively, p=0.042; Figure 1.
Conclusions
Even though invasive management with STEMI reperfusion and mechanical assistance devices, cardiogenic shock in-hospital mortality remains 33% in a contemporary Mediterranean cohort. In this population, IABP shock score provided better 90-days mortality risk prediction than CardShock score
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - T Lopez
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - E Sanz
- University Hospital of Taragona Joan XXIII, Tarragona, Spain
| | | | - J Aboal
- University Hospital de Girona Dr. Josep Trueta, Girona, Spain
| | - C Tomas
- Hospital Arnau de Vilanova, Lleida, Spain
| | - J Baneras
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - A Sionis
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - R Andrea
- Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - A Ariza
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - P Pastor
- Hospital Arnau de Vilanova, Lleida, Spain
| | - I Buera
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - G Cediel
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - F Rueda
- Germans Trias i Pujol University Hospital, Barcelona, Spain
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Buera I, Marcano A, Alcoberro L, Sanchez-Salado J, Lorente V, Lugo L, Ferreiro J, Ariza A, Gomez-Hospital J, Cequier A. P4261Ticagrelor- and prasugrel-mediated platelet inhibition is not affected by mild therapeutic hypothermia generated in vitro in patients with an acute myocardial infarction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mutuberria Urdaniz M, Rodriguez JF, Baneras J, Acosta JG, Buera I, Gonzalez-Alujas MT, Teixido G, Evangelista A, Tornos P, Garcia-Dorado D. Predictors of long term outcome in survivors of prosthetic valve thrombosis: role of medical treatment at discharge. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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