Predictive models of in-hospital deterioration of Society of Cardiovascular Angiography and Intervention shock stage in patients with acute myocardial infarction initially presenting with stable hemodynamic condition.

IF 2.1 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiovascular diagnosis and therapy Pub Date : 2024-12-31 Epub Date: 2024-11-12 DOI:10.21037/cdt-24-226
Takuto Mukaida, Yu Kataoka, Kota Murai, Kenichiro Sawada, Takamasa Iwai, Hideo Matama, Satoshi Honda, Masashi Fujino, Shuichi Yoneda, Kensuke Takagi, Kazuhiro Nakao, Fumiyuki Otsuka, Yoshio Tahara, Yasuhide Asaumi, Teruo Noguchi
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引用次数: 0

Abstract

Background: The Society of Cardiovascular Angiography and Intervention (SCAI) has defined 5 stages of cardiogenic shock (CS). In patients with acute myocardial infarction (AMI) who initially present in stable hemodynamic condition (SCAI CS stage: A or B), CS stages could deteriorate despite therapeutic management. However, deterioration of SCAI CS stages after AMI remains to be fully characterized. Therefore, the current study sought to investigate the frequency and clinical characteristics about deterioration of SCAI CS stages after AMI.

Methods: We retrospectively analyzed 347 patients in a derivation cohort and 163 patients in a validation cohort who had AMI (SCAI shock stage upon arrival: A/B) and underwent percutaneous coronary intervention (PCI) at National Cerebral and Cardiovascular Center, Suita, Japan (enrolment period of study subjects: 2019.07.01-2022.09.30). Deterioration of CS (D-CS) was defined as SCAI shock stage C-E after PCI. Clinical characteristics and in-hospital mortality were compared according to D-CS status. Adjusted hazard ratios (HRs) for in-hospital mortality were calculated with multivariate Cox proportional hazards models that included variables with P<0.10 in univariate models. Uni- and multivariate logistic regression analyses were used to identify predictors of D-CS.

Results: D-CS occurred in 17.3% (60/347) of the derivation cohort. Patients with D-CS had lower systolic blood pressure (BP) (P<0.001) and left ventricular ejection fraction (LVEF) (P<0.001) upon arrival with a higher proportion of initial Thrombolysis in Myocardial Infarction (TIMI) grade flow 0 or 1 (P=0.002). During hospitalization (13.9±9.4 days), D-CS was associated with higher in-hospital mortality [adjusted HR, 12.95; 95% confidence interval (CI): 1.46-114.97; P=0.02]. Initial systolic BP, LVEF, and TIMI grade flow 0 or 1 independently predicted D-CS. The D-CS risk score including these variables satisfactorily predicted D-CS [area under the curve (AUC), 0.749; 95% CI: 0.651-0.848] and in-hospital mortality (AUC, 0.961; 95% CI: 0.914-1.000) in the validation cohort.

Conclusions: D-CS occurred in 17.3% of patients with AMI initially presenting in stable condition and increased the risk of in-hospital mortality. Our D-CS risk score (initial systolic BP, LVEF, and TIMI grade flow) could be helpful to predict D-CS.

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初期血流动力学稳定的急性心肌梗死患者心血管造影学会住院恶化与干预休克期的预测模型
背景:心血管血管造影与干预学会(SCAI)将心源性休克(CS)定义为5个阶段。急性心肌梗死(AMI)患者最初表现为稳定的血流动力学状态(SCAI CS分期:A或B),尽管进行了治疗,CS分期仍可能恶化。然而,AMI后SCAI CS阶段的恶化仍有待充分表征。因此,本研究旨在探讨AMI后SCAI CS期恶化的频率和临床特征。方法:我们回顾性分析了日本水田国立脑心血管中心347例AMI(到达时SCAI休克阶段:a /B)患者和163例验证队列患者(研究对象入组时间:2019.07.01-2022.09.30)的经皮冠状动脉介入治疗(PCI)。CS恶化(D-CS)定义为PCI术后SCAI休克期C-E。根据D-CS状态比较临床特征和住院死亡率。采用多变量Cox比例风险模型计算住院死亡率的校正风险比(hr),该模型包括以下变量:衍生队列中有17.3%(60/347)发生D-CS。D-CS患者的收缩压(BP)较低(结论:17.3%的AMI患者出现D-CS,最初病情稳定,住院死亡风险增加。我们的D-CS风险评分(初始收缩压、LVEF和TIMI级血流)有助于预测D-CS。
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来源期刊
Cardiovascular diagnosis and therapy
Cardiovascular diagnosis and therapy Medicine-Cardiology and Cardiovascular Medicine
CiteScore
4.90
自引率
4.20%
发文量
45
期刊介绍: The journal ''Cardiovascular Diagnosis and Therapy'' (Print ISSN: 2223-3652; Online ISSN: 2223-3660) accepts basic and clinical science submissions related to Cardiovascular Medicine and Surgery. The mission of the journal is the rapid exchange of scientific information between clinicians and scientists worldwide. To reach this goal, the journal will focus on novel media, using a web-based, digital format in addition to traditional print-version. This includes on-line submission, review, publication, and distribution. The digital format will also allow submission of extensive supporting visual material, both images and video. The website www.thecdt.org will serve as the central hub and also allow posting of comments and on-line discussion. The web-site of the journal will be linked to a number of international web-sites (e.g. www.dxy.cn), which will significantly expand the distribution of its contents.
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