Cardiac power index, mean arterial pressure, and Simplified Acute Physiology Score II are strong predictors of survival and response to revascularization in cardiogenic shock.
Short-term prognostic factors in patients with cardiogenic shock (CS) have previously been established using only hemodynamic parameters without taking into account classic intensive care unit (ICU) severity score or organ failure/support. The aim of this study was to assess early predictors of in-hospital mortality of a monocentric cohort of patients with ST-elevation myocardial infarction complicated by early CS. We retrospectively studied 85 consecutive patients with CS complicating acute myocardial infarction and Thrombolysis in Myocardial Infarction flow grade 3 after percutaneous coronary revascularization. All patients were managed according to the following algorithm: initial resuscitation by a mobile medical unit or in-hospital critical care physician unit followed by percutaneous coronary revascularization and CS management in the ICU. Prehospital CS was diagnosed in 69% of cases, initially complicated by an out-of-hospital cardiac arrest in 64% of cases. All patients were treated with vasopressors, 82% were ventilated, and 22% underwent extrarenal epuration. The 28-day mortality rate was 39%. Under multivariate analysis, initial cardiac power index, mean arterial pressure of less than 75 mmHg at hour 6 of ICU management, and Simplified Acute Physiology Score II were independent predictive factors of in-hospital mortality. In conclusion, parameters directly related to cardiac performance and vascular response to vasopressors and admission Simplified Acute Physiology Score II are strong predictors of in-hospital mortality.
*CHU Nancy, Service de Cardiologie Médicale; Pole Cardiovasculaire et Réanimation Médicale, Hôpital Brabois, Vandoeuvre-lès-Nancy; †INSERM, Centre d';Investigation Clinique CIC-P 9501; and ‡CHU Nancy, Service de Réanimation Médicale; Pole Urgences-Réanimation Médicale, Hopital Central, Nancy; §CHU Nancy, Service de Réanimation Médicale Brabois Médicale; Pole Cardiovasculaire et Réanimation Médicale, Hôpital Brabois; and ∥INSERM, Groupe Choc, Faculté de Médecine, Vandoeuvre-lès-Nancy; and ¶Université de Lorraine, Nancy, France.
Batric
B
Popovic
Renaud
R
Fay
Aurelie
A
Cravoisy-Popovic
Bruno
B
Levy
D000368:Aged; D062186:Arterial Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D016019:Survival Analysis; D016896:Treatment Outcome