The Range of Cardiogenic Shock Survival by Clinical Stage: Data From the Critical Care Cardiology Trials Network Registry.

Abstract

OBJECTIVES:

Cardiogenic shock presents with variable severity. Categorizing cardiogenic shock into clinical stages may improve risk stratification and patient selection for therapies. We sought to determine whether a structured implementation of the 2019 Society for Cardiovascular Angiography and Interventions clinical cardiogenic shock staging criteria that is ascertainable in clinical registries discriminates mortality in a contemporary population with or at-risk for cardiogenic shock.

DESIGN:

We developed a pragmatic application of the Society for Cardiovascular Angiography and Interventions cardiogenic shock staging criteria-A (at-risk), B (beginning), C (classic cardiogenic shock), D (deteriorating), or E (extremis)-and examined outcomes by stage.

SETTING:

The Critical Care Cardiology Trials Network is an investigator-initiated multicenter research collaboration coordinated by the TIMI Study Group (Boston, MA). Consecutive admissions with or at-risk for cardiogenic shock during two annual 2-month collection periods (2017-2019) were analyzed.

PATIENTS:

Patients with or at-risk for cardiogenic shock.

MEASUREMENTS AND MAIN RESULTS:

Of 8,240 CICU admissions reviewed, 1,991 (24%) had or were at-risk for cardiogenic shock. Distributions across the five stages were as follows: A: 33%; B: 7%; C: 16%; D: 23%; and E: 21%. Overall in-hospital mortality among patients with established cardiogenic shock was 39%; however, mortality varied from only 15.8% to 32.1% to 62.5% across stages C, D, and E (Cochran-Armitage ptrend < 0.0001). The Society for Cardiovascular Angiography and Interventions stages improved mortality prediction beyond the Sequential Organ Failure Assessment and Intra-Aortic Balloon Pumpin Cardiogenic Shock II scores.

CONCLUSIONS:

Although overall mortality in cardiogenic shock remains high, it varies considerably based on clinical stage, identifying stage C as relatively lower risk. We demonstrate a pragmatic adaptation of the Society for Cardiovascular Angiography and Interventions cardiogenic shock stages that effectively stratifies mortality risk and could be leveraged for future clinical research.

• Authors: Patrick R Lawler, David D Berg, Jeong-Gun Park, Jason N Katz, Vivian M Baird-Zars, Gregory W Barsness, Erin A Bohula, Anthony P Carnicelli, Sunit-Preet Chaudhry, Jacob C Jentzer, Venu Menon, Thomas Metkus, Jose Nativi-Nicolau, Nicholas Phreaner, Shashank S Sinha, Jeffrey J Teuteberg, Sean van Diepen, David A Morrow, Critical Care Cardiology Trials Network Investigators
• Journal: Critical care medicine (Crit Care Med) Vol. 49 Issue 8 Pg. 1293-1302 (08 01 2021) ISSN: 1530-0293 [Electronic] United States
• PMID: 33861557 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

Topics

• Coronary Care Units
• Critical Care (statistics & numerical data)
• Female
• Hospital Mortality
• Humans
• Male
• Registries
• Risk Assessment
• Severity of Illness Index
• Shock, Cardiogenic (mortality, therapy)
• Survivors (statistics & numerical data)