Queb PNM, Rocha BE, Gaytán GCJ, Aguirre SJS, Martínez DBA

Language: Spanish
References: 11
Page: 419-426
PDF size: 303.53 Kb.

ABSTRACT

Introduction: cardiogenic shock (CS) is a syndrome that results in prolonged stays in intensive care units, increases long-term morbidity, and comes with significant economic costs and impacts on survivors' health-related quality of life. The Cardiogenic Shock Working Group (CSWG) proposed a sub-classification of CS into three phenotypes, synergistically associated with the Society for Cardiovascular Angiography and Interventions (SCAI) classification to improve prognostic correlation. Objective: our research aims to explore the incidence of each CS phenotype and its association with mortality in an intensive care setting in Mexico. Material and methods: this is a historical cohort study that included patients admitted to the intensive care unit with a diagnosis of CS according to CSWG and SCAI criteria. The study included phenotypes in stages C, D, and E. Results: from January 2021 to January 2023, 65 patients admitted to the intensive care unit with a diagnosis of CS were studied. Of these, 55% (n = 36) were men, and 45% (n = 29) were women, with an average age of 65.7 ± 15.2 years. The distribution by phenotypes was 49% corresponding to phenotype I, 40% to phenotype II, and 11% to phenotype III. Mortality rates were 46% for phenotype I, 27% for phenotype II, and 27% for phenotype III. According to SCAI staging, 2% of the patients were identified in stage C, 72% in stage D, and 26% in stage E. The primary etiology was decompensated heart failure, and pharmacological treatment predominated, with only 7.6% receiving mechanical support. Conclusion: it was possible to determine the incidence of each CS phenotype and its association with mortality; the main cause of mortality by phenotype observed in our population differs from previous studies, potentially due to the predominant etiology in our population. This study is the first to examine phenotype classification in our country and establish its association with mortality and SCAI classification, highlighting the need for prospective studies with larger cohorts.

REFERENCES

1. Chien SC, Wang CA, Liu HY, Lin CF, Huang CY, Chien LN. Comparison of the prognosis among in-hospital survivors of cardiogenic shock based on etiology: AMI and Non-AMI. Ann Intensiv Care. 2024;14(1):74.

2. Shirakabe A, Matsushita M, Shibata Y, Shighihara S, Nishigoori S, Sawatani T, et al. Organ dysfunction, injury, and failure in cardiogenic shock. J Intensiv Care. 2023;11(1):26.

3. Camacho CEG, Sigarroa ER, Cherit GD. Choque cardiogénico: de la definición al abordaje. Med Crtt. 2019;33(5):251-258.

4. Sarma D, Jentzer JC, Soussi S. Cardiogenic shock: a major challenge for the clinical trialist. Curr Opin Crit Care. 2023;29(4):371-380.

5. Kapur NK, Kanwar M, Sinha SS, Thayer KL, Garan AR, Hernandez-Montfort J, et al. Criteria for defining stages of cardiogenic shock severity. J Am Coll Cardiol. 2022;80(3):185-198.

6. Tehrani BN, Truesdell AG, Psotka MA, Rosner C, Singh R, Sinha SS, et al. A standardized and comprehensive approach to the management of cardiogenic shock. Jacc Hear Fail. 2020;8(11):879-891.

7. Zweck E, Thayer KL, Helgestad OKL, Kanwar M, Ayouty M, Garan AR, et al. Phenotyping cardiogenic shock. J Am Hear Assoc: Cardiovasc Cerebrovasc Dis. 2020;10(14):e020085.

8. Jones TL, Nakamura K, McCabe JM. Cardiogenic shock: evolving definitions and future directions in management. Open Hear. 2019;6(1):e000960.

9. Zweck E, Kanwar M, Li S, Sinha SS, Garan AR, Hernandez-Montfort J, et al. Clinical course of patients in cardiogenic shock stratified by phenotype. JACC: Hear Fail. 2023;11(10):1304-1315.

10. Geller BJ, Sinha SS, Kapur NK, Bakitas M, Balsam LB, Chikwe J, et al. Escalating and de-escalating temporary mechanical circulatory support in cardiogenic shock: a scientific statement from the American Heart Association. Circulation. 2022;146(6):e50-e68.

11. Lim HS. Phenotyping and hemodynamic assessment in cardiogenic shock: from physiology to clinical application. Cardiol Ther. 2022;11(4):509-522.