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Alviar CL, Li BK, Keller NM, Bohula-May E, Barnett C, Berg DD, Burke JA, Chaudhry SP, Daniels LB, DeFilippis AP, Gerber D, Horowitz J, Jentzer JC, Katrapati P, Keeley E, Lawler PR, Park JG, Sinha SS, Snell J, Solomon MA, Teuteberg J, Katz JN, van Diepen S, Morrow DA. Prognostic performance of the IABP-SHOCK II Risk Score among cardiogenic shock subtypes in the critical care cardiology trials network registry. Am Heart J 2024; 270:1-12. [PMID: 38190931 DOI: 10.1016/j.ahj.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Risk stratification has potential to guide triage and decision-making in cardiogenic shock (CS). We assessed the prognostic performance of the IABP-SHOCK II score, derived in Europe for acute myocardial infarct-related CS (AMI-CS), in a contemporary North American cohort, including different CS phenotypes. METHODS The critical care cardiology trials network (CCCTN) coordinated by the TIMI study group is a multicenter network of cardiac intensive care units (CICU). Participating centers annually contribute ≥2 months of consecutive medical CICU admissions. The IABP-SHOCK II risk score includes age > 73 years, prior stroke, admission glucose > 191 mg/dl, creatinine > 1.5 mg/dl, lactate > 5 mmol/l, and post-PCI TIMI flow grade < 3. We assessed the risk score across various CS etiologies. RESULTS Of 17,852 medical CICU admissions 5,340 patients across 35 sites were admitted with CS. In patients with AMI-CS (n = 912), the IABP-SHOCK II score predicted a >3-fold gradient in in-hospital mortality (low risk = 26.5%, intermediate risk = 52.2%, high risk = 77.5%, P < .0001; c-statistic = 0.67; Hosmer-Lemeshow P = .79). The score showed a similar gradient of in-hospital mortality in patients with non-AMI-related CS (n = 2,517, P < .0001) and mixed shock (n = 923, P < .001), as well as in left ventricular (<0.0001), right ventricular (P = .0163) or biventricular (<0.0001) CS. The correlation between the IABP-SHOCK II score and SOFA was moderate (r2 = 0.17) and the IABP-SHOCK II score revealed a significant risk gradient within each SCAI stage. CONCLUSIONS In an unselected international multicenter registry of patients admitted with CS, the IABP- SHOCK II score only moderately predicted in-hospital mortality in a broad population of CS regardless of etiology or irrespective of right, left, or bi-ventricular involvement.
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Affiliation(s)
- Carlos L Alviar
- The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY;.
| | - Boyangzi K Li
- Division of Cardiology, University of Miami, Miami, FL
| | - Norma M Keller
- The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY
| | - Erin Bohula-May
- Levine Cardiac Intensive Care Unit, Brigham and Women's Hospital, Boston, MA
| | - Christopher Barnett
- Division of Cardiology, University of California San Francisco, San Francisco, CA
| | - David D Berg
- Levine Cardiac Intensive Care Unit, Brigham and Women's Hospital, Boston, MA
| | - James A Burke
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA
| | | | - Lori B Daniels
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA
| | | | - Daniel Gerber
- Division of Cardiology, Stanford University, Stanford, CA
| | - James Horowitz
- The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY
| | - Jacob C Jentzer
- Division of Cardiovascular Medicine, Mayo Clinic, Minnesota, CA
| | | | - Ellen Keeley
- Division of Cardiology, University of Florida, Gainesville, FL
| | - Patrick R Lawler
- McGill University Health Centre, Montreal, Quebec, Canada;; Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Jeong-Gun Park
- Levine Cardiac Intensive Care Unit, Brigham and Women's Hospital, Boston, MA
| | - Shashank S Sinha
- Inova Fairfax Medical Campus, Inova Heart and Vascular Institute, Falls Church, VA
| | - Jeffrey Snell
- Division of Cardiology, Rush University, Chicago, IL
| | - Michael A Solomon
- Critical Care Medicine Department, National Institutes of Health Clinical Center and Cardiovascular Branch, National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, MD
| | | | - Jason N Katz
- The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY
| | - Sean van Diepen
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - David A Morrow
- Levine Cardiac Intensive Care Unit, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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D'Elia N, Vogrin S, Brennan AL, Dinh D, Lefkovits J, Reid CM, Stub D, Bloom J, Haji K, Noaman S, Kaye DM, Cox N, Chan W. Electrocardiographic patterns and clinical outcomes of acute coronary syndrome cardiogenic shock in patients undergoing percutaneous coronary intervention - A propensity score analysis. Cardiovasc Revasc Med 2024:S1553-8389(24)00075-7. [PMID: 38448259 DOI: 10.1016/j.carrev.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/16/2024] [Accepted: 02/28/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVES To determine the influence of presenting electrocardiographic (ECG) changes on prognosis in acute coronary syndrome cardiogenic shock (ACS-CS) patients undergoing percutaneous coronary angiography (PCI). BACKGROUND The effect of initial ECG changes such as ST-elevation myocardial infarction (STEMI) versus non-STEMI among patients ACS-CS on prognosis remains unclear. METHODS We analysed data from consecutive patients with ACS-CS enrolled in the Victorian Cardiac Outcomes registry between 2014 and 2020. Inverse probability of treatment weighting analysis (IPTW) was used to assess the effect of ECG changes on 30-day mortality. RESULTS Of 1564 patients with ACS-CS who underwent PCI, 161 had non-STEMI and 1403 had STEMI on ECG. The mean age was 66 ± 13 years, and 74 % (1152) were males. Patients with non-STEMI compared to STEMI were older (70 ± 12 vs 65 ± 13 years), had higher rates of diabetes (34 % vs 21 %), prior coronary artery bypass graft surgery (14 % vs 3.3 %), peripheral arterial disease (10.6 % vs 4.1 %, p < 0.01), and lower baseline eGFR (53.8 [37.1, 75.4] vs 65.3 [46.3, 87.8] ml/min/1.73m2), all p ≤ 0.01. Non-STEMI patients were more likely to have a culprit left circumflex artery (29 % vs 20 %) and more often underwent multivessel percutaneous coronary intervention (30 % vs 20 %) but had lower rates of out-of-hospital cardiac arrest (21 % vs 39 %), all p ≤ 0.01. Propensity score analysis with IPTW confirmed that non-STEMI ECG was associated with lower odds for 30-day all-cause mortality (OR 0.47 [0.32, 0.69], p < 0.001), and 30-day major adverse cardiovascular and cerebrovascular events (OR 0.48 [0.33, 0.70]). CONCLUSIONS In patients undergoing PCI, Non-STEMI as compared to STEMI on index ECG was associated with approximately half the relative risk of both 30-day mortality and 30-day MACCE and could be a useful variable to integrate in ACS-CS risk scores.
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Affiliation(s)
- Nicholas D'Elia
- Western Health Department of Cardiology, Victoria, Australia; Baker Heart and Diabetes Institute, Victoria, Australia
| | - Sara Vogrin
- Department of Medicine, University of Melbourne, Victoria, Australia
| | - Angela L Brennan
- Centre of Cardiovascular Research & Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Diem Dinh
- Centre of Cardiovascular Research & Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Jeffrey Lefkovits
- Centre of Cardiovascular Research & Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; Department of Cardiology, Royal Melbourne Hospital, Victoria, Australia
| | - Christopher M Reid
- Centre of Cardiovascular Research & Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Dion Stub
- Western Health Department of Cardiology, Victoria, Australia; School Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Department of Cardiology, Alfred Hospital, Victoria, Australia
| | - Jason Bloom
- Baker Heart and Diabetes Institute, Victoria, Australia
| | - Kawa Haji
- Western Health Department of Cardiology, Victoria, Australia
| | - Samer Noaman
- Western Health Department of Cardiology, Victoria, Australia; Baker Heart and Diabetes Institute, Victoria, Australia; Department of Cardiology, Alfred Hospital, Victoria, Australia
| | - David M Kaye
- Baker Heart and Diabetes Institute, Victoria, Australia; Department of Cardiology, Alfred Hospital, Victoria, Australia
| | - Nicholas Cox
- Western Health Department of Cardiology, Victoria, Australia; Department of Medicine, Western Health, University of Melbourne, St Albans, Victoria, Australia
| | - William Chan
- Western Health Department of Cardiology, Victoria, Australia; Baker Heart and Diabetes Institute, Victoria, Australia; Department of Medicine, University of Melbourne, Victoria, Australia; Department of Cardiology, Alfred Hospital, Victoria, Australia; Department of Medicine, Western Health, University of Melbourne, St Albans, Victoria, Australia.
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Abe T, Olanipekun T, Igwe J, Ndausung U, Amah C, Chang A, Effoe V, Egbuche O, Ogunbayo G, Onwuanyi A. Incidence and predictors of sudden cardiac arrest in the immediate post-percutaneous coronary intervention period for ST-elevation myocardial infarction: a single-center study. Coron Artery Dis 2022; 33:261-268. [PMID: 35102067 DOI: 10.1097/mca.0000000000001119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Data on the incidence, predictors, and outcomes of sudden cardiac arrest (SCA) in the immediate post-percutaneous coronary intervention (PCI) period for ST-elevation myocardial infarction (STEMI) are limited. OBJECTIVES The study aimed to investigate the trends and predictors of SCA occurring within 48 h post PCI for STEMI. METHODS We systematically reviewed data from the electronic medical records of 403 patients who underwent PCI for STEMI between January 2014 and December 2019. Trends in the incidence of SCA 48 h post PCI for STEMI were assessed using the Cochrane-Armitage test. Multivariable logistic regression was used to determine the predictors of SCA within 48 h post PCI for STEMI. RESULTS Of the 403 patients who underwent PCI for STEMI, 44 (11%) had SCA within 48 h post PCI. The incidence of SCA within 48 h post PCI decreased from 22% in 2014 to 8% in 2019; P = 0.03. After adjusting for underlying confounding variables in the multivariable logistic regression models, out of hospital cardiac arrest [adjusted odds ratio (aOR), 23.9; confidence interval (CI), 10.2-56.1], left main coronary artery disease (aOR, 3.1; CI, 1.1-9.4), left main PCI (aOR, 6.6; CI: 1.4-31.7), new-onset heart failure (aOR, 2.0; CI, 4.3-9.4), and cardiogenic shock (aOR, 5.8; CI, 1.7-20.2) were statistically significant predictors of SCA within 48 h post PCI for STEMI. CONCLUSION We identified essential factors associated with SCA within 48 h post PCI for STEMI. Future studies are needed to devise effective strategies to decrease the risk of SCA in the early post-PCI period.
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Affiliation(s)
- Temidayo Abe
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | | | - Joseph Igwe
- Department of Medicine, Internal Medicine Residency Program, Morehouse School of Medicine, Atlanta, Georgia
| | - Udongwo Ndausung
- Department of Medicine, Internal Medicine Residency Program, Jersey Shore University Medical Center, Neptune, New Jersey
| | - Chidi Amah
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Albert Chang
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Valery Effoe
- Department of Cardiovascular Disease, Morehouse School of Medicine, Atlanta, Georgia
| | - Obiora Egbuche
- Department of Cardiovascular Disease, Morehouse School of Medicine, Atlanta, Georgia
| | - Gbolahan Ogunbayo
- Department of Internal Medicine, Division of Cardiology, University of Kentucky, Lexington, Kentucky, USA
| | - Anekwe Onwuanyi
- Department of Cardiovascular Disease, Morehouse School of Medicine, Atlanta, Georgia
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