{"title":"诊断后 72 小时内的连续休克严重程度评估:心源性休克工作组报告。","authors":"","doi":"10.1016/j.jacc.2024.04.069","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>The Cardiogenic Shock Working Group–modified Society for Cardiovascular Angiography and Interventions (CSWG-SCAI) staging was developed to risk stratify cardiogenic shock (CS) severity. Data showing progressive changes in SCAI stages and outcomes are limited.</p></div><div><h3>Objectives</h3><p>We investigated serial changes in CSWG-SCAI stages and outcomes of patients presenting with cardiogenic shock complicating acute myocardial infarction (MI-CS) and heart failure–related CS (HF-CS).</p></div><div><h3>Methods</h3><p>The multicenter CSWG registry was queried. CSWG-SCAI stages were computed at CS diagnosis and 24, 48, and 72 hours.</p></div><div><h3>Results</h3><p>A total of 3,268 patients (57% HF-CS; 27% MI-CS) were included. At CS diagnosis, CSWG-SCAI stage breakdown was 593 (18.1%) stage B, 528 (16.2%) stage C, 1,659 (50.8%) stage D, and 488 (14.9%) noncardiac arrest stage E. At 24 hours, >50% of stages B and C patients worsened, but 86% of stage D patients stayed at stage D. Among stage E patients, 54% improved to stage D and 36% stayed at stage E by 24 hours. Minimal SCAI stage changes occurred beyond 24 hours. SCAI stage trajectories were similar between MI-CS and HF-CS groups. Within 24 hours, unadjusted mortality rates of patients with any SCAI stage worsening or improving were 44.6% and 34.2%, respectively. Patients who presented in or progressed to stage E by 24 hours had the worst prognosis. Survivors had lower lactate than nonsurvivors.</p></div><div><h3>Conclusions</h3><p>Most patients with CS changed SCAI stages within 24 hours from CS diagnosis. Stage B patients were at high risk of worsening shock severity by 24 hours, associated with excess mortality. Early CS recognition and serial assessment may improve risk stratification.</p></div>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":null,"pages":null},"PeriodicalIF":21.7000,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Serial Shock Severity Assessment Within 72 Hours After Diagnosis\",\"authors\":\"\",\"doi\":\"10.1016/j.jacc.2024.04.069\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>The Cardiogenic Shock Working Group–modified Society for Cardiovascular Angiography and Interventions (CSWG-SCAI) staging was developed to risk stratify cardiogenic shock (CS) severity. Data showing progressive changes in SCAI stages and outcomes are limited.</p></div><div><h3>Objectives</h3><p>We investigated serial changes in CSWG-SCAI stages and outcomes of patients presenting with cardiogenic shock complicating acute myocardial infarction (MI-CS) and heart failure–related CS (HF-CS).</p></div><div><h3>Methods</h3><p>The multicenter CSWG registry was queried. CSWG-SCAI stages were computed at CS diagnosis and 24, 48, and 72 hours.</p></div><div><h3>Results</h3><p>A total of 3,268 patients (57% HF-CS; 27% MI-CS) were included. At CS diagnosis, CSWG-SCAI stage breakdown was 593 (18.1%) stage B, 528 (16.2%) stage C, 1,659 (50.8%) stage D, and 488 (14.9%) noncardiac arrest stage E. At 24 hours, >50% of stages B and C patients worsened, but 86% of stage D patients stayed at stage D. Among stage E patients, 54% improved to stage D and 36% stayed at stage E by 24 hours. Minimal SCAI stage changes occurred beyond 24 hours. SCAI stage trajectories were similar between MI-CS and HF-CS groups. Within 24 hours, unadjusted mortality rates of patients with any SCAI stage worsening or improving were 44.6% and 34.2%, respectively. Patients who presented in or progressed to stage E by 24 hours had the worst prognosis. Survivors had lower lactate than nonsurvivors.</p></div><div><h3>Conclusions</h3><p>Most patients with CS changed SCAI stages within 24 hours from CS diagnosis. Stage B patients were at high risk of worsening shock severity by 24 hours, associated with excess mortality. Early CS recognition and serial assessment may improve risk stratification.</p></div>\",\"PeriodicalId\":17187,\"journal\":{\"name\":\"Journal of the American College of Cardiology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":21.7000,\"publicationDate\":\"2024-08-31\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the American College of Cardiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0735109724077404\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American College of Cardiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0735109724077404","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景:心源性休克工作组修订版心血管造影和介入学会(CSWG-SCAI)分期用于对心源性休克(CS)严重程度进行风险分层。显示 SCAI 分期和预后逐渐变化的数据非常有限:我们调查了急性心肌梗死(MI-CS)和心衰相关 CS(HF-CS)并发心源性休克患者 CSWG-SCAI 分期和预后的连续变化:方法:查询多中心 CSWG 登记。方法:对多中心 CSWG 注册表进行查询,计算 CSWG-SCAI 分级,时间为 CS 诊断时、24、48 和 72 小时:结果:共纳入 3268 名患者(57% 为高频 CS;27% 为心肌梗死 CS)。CS 诊断时,CSWG-SCAI 分期细分为 B 期 593 例(18.1%)、C 期 528 例(16.2%)、D 期 1,659 例(50.8%)和非心脏骤停 E 期 488 例(14.9%)。24 小时后,超过 50% 的 B 期和 C 期患者病情恶化,但 86% 的 D 期患者维持在 D 期。超过 24 小时后,SCAI 分期变化极小。MI-CS 组和 HF-CS 组的 SCAI 分期轨迹相似。在 24 小时内,任何 SCAI 阶段恶化或改善的患者的未调整死亡率分别为 44.6% 和 34.2%。24 小时内出现 E 期或进展至 E 期的患者预后最差。幸存者的乳酸低于非幸存者:大多数CS患者在确诊后24小时内改变了SCAI分期。B期患者在24小时内休克严重程度恶化的风险很高,死亡率也较高。早期 CS 识别和连续评估可改善风险分层。
Serial Shock Severity Assessment Within 72 Hours After Diagnosis
Background
The Cardiogenic Shock Working Group–modified Society for Cardiovascular Angiography and Interventions (CSWG-SCAI) staging was developed to risk stratify cardiogenic shock (CS) severity. Data showing progressive changes in SCAI stages and outcomes are limited.
Objectives
We investigated serial changes in CSWG-SCAI stages and outcomes of patients presenting with cardiogenic shock complicating acute myocardial infarction (MI-CS) and heart failure–related CS (HF-CS).
Methods
The multicenter CSWG registry was queried. CSWG-SCAI stages were computed at CS diagnosis and 24, 48, and 72 hours.
Results
A total of 3,268 patients (57% HF-CS; 27% MI-CS) were included. At CS diagnosis, CSWG-SCAI stage breakdown was 593 (18.1%) stage B, 528 (16.2%) stage C, 1,659 (50.8%) stage D, and 488 (14.9%) noncardiac arrest stage E. At 24 hours, >50% of stages B and C patients worsened, but 86% of stage D patients stayed at stage D. Among stage E patients, 54% improved to stage D and 36% stayed at stage E by 24 hours. Minimal SCAI stage changes occurred beyond 24 hours. SCAI stage trajectories were similar between MI-CS and HF-CS groups. Within 24 hours, unadjusted mortality rates of patients with any SCAI stage worsening or improving were 44.6% and 34.2%, respectively. Patients who presented in or progressed to stage E by 24 hours had the worst prognosis. Survivors had lower lactate than nonsurvivors.
Conclusions
Most patients with CS changed SCAI stages within 24 hours from CS diagnosis. Stage B patients were at high risk of worsening shock severity by 24 hours, associated with excess mortality. Early CS recognition and serial assessment may improve risk stratification.
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