Epidemiology of cardiogenic shock using the Shock Academic Research Consortium (SHARC) consensus definitions.

IF 3.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS European Heart Journal: Acute Cardiovascular Care Pub Date : 2024-10-28 DOI:10.1093/ehjacc/zuae098
David D Berg, Erin A Bohula, Siddharth M Patel, Carlos E Alfonso, Carlos L Alviar, Vivian M Baird-Zars, Christopher F Barnett, Gregory W Barsness, Courtney E Bennett, Sunit-Preet Chaudhry, Christopher B Fordyce, Shahab Ghafghazi, Umesh K Gidwani, Michael J Goldfarb, Jason N Katz, Venu Menon, P Elliott Miller, L Kristin Newby, Alexander I Papolos, Jeong-Gun Park, Matthew J Pierce, Alastair G Proudfoot, Shashank S Sinha, Lakshmi Sridharan, Andrea D Thompson, Sean van Diepen, David A Morrow
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Abstract

Aims: The Shock Academic Research Consortium (SHARC) recently proposed pragmatic consensus definitions to standardize classification of cardiogenic shock (CS) in registries and clinical trials. We aimed to describe contemporary CS epidemiology using the SHARC definitions in a cardiac intensive care unit (CICU) population.

Methods and results: The Critical Care Cardiology Trials Network (CCCTN) is a multinational research network of advanced CICUs coordinated by the TIMI Study Group (Boston, MA). Cardiogenic shock was defined as a cardiac disorder resulting in SBP < 90 mmHg for ≥30 min [or the need for vasopressors, inotropes, or mechanical circulatory support (MCS) to maintain SBP ≥ 90 mmHg] with evidence of hypoperfusion. Primary aetiologic categories included acute myocardial infarction-related CS (AMI-CS), heart failure-related CS (HF-CS), and non-myocardial (secondary) CS. Post-cardiotomy CS was not included. Heart failure-related CS was further subcategorized as de novo vs. acute-on-chronic HF-CS. Patients with both cardiogenic and non-cardiogenic components of shock were classified separately as mixed CS. Of 8974 patients meeting shock criteria (2017-23), 65% had isolated CS and 17% had mixed shock. Among patients with CS (n = 5869), 27% had AMI-CS (65% STEMI), 59% HF-CS (72% acute-on-chronic, 28% de novo), and 14% secondary CS. Patients with AMI-CS and de novo HF-CS were most likely to have had concomitant cardiac arrest (P < 0.001). Patients with AMI-CS and mixed CS were most likely to present in more severe shock stages (SCAI D or E; P < 0.001). Temporary MCS use was highest in AMI-CS (59%). In-hospital mortality was highest in mixed CS (48%), followed by AMI-CS (41%), similar in de novo HF-CS (31%) and secondary CS (31%), and lowest in acute-on-chronic HF-CS (25%; P < 0.001).

Conclusion: SHARC consensus definitions for CS classification can be pragmatically applied in contemporary registries and reveal discrete subpopulations of CS with distinct phenotypes and outcomes that may be relevant to clinical practice and future research.

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使用休克学术研究联盟 (SHARC) 共识定义的心源性休克流行病学。
背景:休克学术研究联盟(SHARC)最近提出了务实的共识定义,以规范登记册和临床试验中的心源性休克(CS)分类。我们旨在使用 SHARC 定义描述心脏重症监护病房(CICU)人群中的当代 CS 流行病学:重症监护心脏病学试验网络(CCCTN)是由 TIMI 研究小组(马萨诸塞州波士顿)协调的先进重症监护病房的跨国研究网络。CS被定义为导致SBPR的心脏疾病:在符合休克标准(2017-2023 年)的 8974 名患者中,65% 患有孤立性 CS,17% 患有混合性休克。在CS患者(n=5869)中,27%患有AMI-CS(65%为STEMI),59%患有HF-CS(72%为急性-慢性,28%为新发),14%为继发性CS。AMI-CS和新发HF-CS患者最有可能同时患有心脏骤停(p结论:SHARC关于CS分类的共识定义可实际应用于当代登记中,并揭示了具有不同表型和结局的CS亚群,这些表型和结局可能与临床实践和未来研究相关。
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来源期刊
CiteScore
8.50
自引率
4.90%
发文量
325
期刊介绍: The European Heart Journal - Acute Cardiovascular Care (EHJ-ACVC) offers a unique integrative approach by combining the expertise of the different sub specialties of cardiology, emergency and intensive care medicine in the management of patients with acute cardiovascular syndromes. Reading through the journal, cardiologists and all other healthcare professionals can access continuous updates that may help them to improve the quality of care and the outcome for patients with acute cardiovascular diseases.
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