Using a Cardiogenic Shock Classification System for Predicting Postcardiotomy Shock Mortality

JACC. Asia Pub Date : 2025-05-01 DOI:10.1016/j.jacasi.2025.01.007

Yiwen Wang MD , Chenglong Li MD , Liangshan Wang MD, Xing Hao MD, Xiaomeng Wang MD, Tingting Wu MD, Dengbang Hou MD, Ming Jia MD, Feng Yang MD, Zhongtao Du MD, Hong Wang MD, PhD, Xiaotong Hou MD, PhD

{"title":"Using a Cardiogenic Shock Classification System for Predicting Postcardiotomy Shock Mortality","authors":"Yiwen Wang MD , Chenglong Li MD , Liangshan Wang MD, Xing Hao MD, Xiaomeng Wang MD, Tingting Wu MD, Dengbang Hou MD, Ming Jia MD, Feng Yang MD, Zhongtao Du MD, Hong Wang MD, PhD, Xiaotong Hou MD, PhD","doi":"10.1016/j.jacasi.2025.01.007","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Cardiogenic shock (CS) is a life-threatening hemodynamic state. Patients with differing shock severity show varying responsiveness to clinical interventions. CS also occurs in patients who have undergone cardiac surgery. A few evaluation systems have been developed for postcardiotomy patients. The Society for Cardiovascular Angiography and Intervention (SCAI) has developed a new classification scheme for CS.</div></div><div><h3>Objectives</h3><div>This study aimed to assess the parameters that define the stages of CS and the diagnostic utility of an SCAI-based CS classification system for patients undergoing cardiac surgery to inform the prediction of outcomes.</div></div><div><h3>Methods</h3><div>This single-center, retrospective, observational study included 8,335 consecutive adult patients undergoing cardiac surgery from January to December 2022. This cohort was divided into 5 groups based on lactate and types of intervention received, including vasopressors and mechanical circulatory support systems. The primary outcome was in-hospital mortality.</div></div><div><h3>Results</h3><div>CS occurred in 970 (11.1%) patients of this cohort. The frequencies of distribution of various postcardiotomy shock stages differed significantly: stage A = 4,747 (57.0%), stage B = 2,658 (31.9%), stage C = 779 (9.3%), stage D = 64 (0.8%), and stage E = 87 (1.0%) (<em>P <</em> 0.001) patients. In-hospital mortality was 1.1% (94 of 8,335). A progressive increase in the stage of the disease led to a clear stepwise increase in in-hospital mortality: Stage A = 0.4% (19 of 4747), Stage B = 0.8% (21 of 2658), Stage C = 2.8% (22 of 779), Stage D = 7.8% (5 of 64), and Stage E = 31.0% (27 of 87) (<em>P <</em> 0.001). The area under the receiver-operating curve of this classification for postcardiotomy CS was 0.781 (95% CI: 0.746-0.815).</div></div><div><h3>Conclusions</h3><div>In this single-center postcardiotomy population, CS occurred in 11.1% of patients. Postcardiotomy SCAI-derived criteria for CS severity suggested a good correlation with in-hospital mortality.</div></div>","PeriodicalId":73529,"journal":{"name":"JACC. Asia","volume":"5 5","pages":"Pages 663-676"},"PeriodicalIF":0.0000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JACC. Asia","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2772374725000523","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Cardiogenic shock (CS) is a life-threatening hemodynamic state. Patients with differing shock severity show varying responsiveness to clinical interventions. CS also occurs in patients who have undergone cardiac surgery. A few evaluation systems have been developed for postcardiotomy patients. The Society for Cardiovascular Angiography and Intervention (SCAI) has developed a new classification scheme for CS.

Objectives

This study aimed to assess the parameters that define the stages of CS and the diagnostic utility of an SCAI-based CS classification system for patients undergoing cardiac surgery to inform the prediction of outcomes.

Methods

This single-center, retrospective, observational study included 8,335 consecutive adult patients undergoing cardiac surgery from January to December 2022. This cohort was divided into 5 groups based on lactate and types of intervention received, including vasopressors and mechanical circulatory support systems. The primary outcome was in-hospital mortality.

Results

CS occurred in 970 (11.1%) patients of this cohort. The frequencies of distribution of various postcardiotomy shock stages differed significantly: stage A = 4,747 (57.0%), stage B = 2,658 (31.9%), stage C = 779 (9.3%), stage D = 64 (0.8%), and stage E = 87 (1.0%) (P < 0.001) patients. In-hospital mortality was 1.1% (94 of 8,335). A progressive increase in the stage of the disease led to a clear stepwise increase in in-hospital mortality: Stage A = 0.4% (19 of 4747), Stage B = 0.8% (21 of 2658), Stage C = 2.8% (22 of 779), Stage D = 7.8% (5 of 64), and Stage E = 31.0% (27 of 87) (P < 0.001). The area under the receiver-operating curve of this classification for postcardiotomy CS was 0.781 (95% CI: 0.746-0.815).

Conclusions

In this single-center postcardiotomy population, CS occurred in 11.1% of patients. Postcardiotomy SCAI-derived criteria for CS severity suggested a good correlation with in-hospital mortality.

查看原文本刊更多论文

使用心源性休克分类系统预测心切术后休克死亡率

心源性休克（CS）是一种危及生命的血液动力学状态。不同休克严重程度的患者对临床干预表现出不同的反应。接受过心脏手术的患者也会发生CS。一些评估系统已经开发出来用于心脏切开术后的患者。心血管血管造影与干预学会（SCAI）已经为CS制定了一个新的分类方案。目的本研究旨在评估定义CS分期的参数，以及基于scai的CS分类系统对心脏手术患者的诊断效用，以预测预后。方法本研究为单中心、回顾性、观察性研究，纳入2022年1月至12月接受心脏手术的8335例连续成人患者。该队列根据乳酸水平和接受的干预类型（包括血管加压剂和机械循环支持系统）分为5组。主要终点是住院死亡率。结果该队列中970例（11.1%）患者出现scs。开心术后休克各阶段的分布频率差异显著：A期4747例（57.0%），B期2658例（31.9%），C期779例（9.3%），D期64例（0.8%），E期87例（1.0%）(P <；0.001)患者。住院死亡率为1.1%（8,335人中有94人）。疾病分期的逐渐增加导致住院死亡率明显逐步增加：A期= 0.4%（4747例中19例），B期= 0.8%（2658例中21例），C期= 2.8%（779例中22例），D期= 7.8%（64例中5例），E期= 31.0%（87例中27例）(P <；0.001)。该分类在开心术后CS的受者-手术曲线下面积为0.781 （95% CI: 0.746-0.815）。结论：在单中心心脏切开术后人群中，CS发生率为11.1%。心脏切开术后scai衍生的CS严重程度标准提示与院内死亡率有良好的相关性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

JACC. Asia Cardiology and Cardiovascular Medicine

CiteScore

4.00

自引率

0.00%

发文量