학술논문
Early Serial Assessment of Aggregate Vasoactive Support and Mortality in Cardiogenic Shock: Insights From the Critical Care Cardiology Trials Network Registry
Document Type
Academic Journal
Author
Patel, Siddharth M.; Berg, David D.; Bohula, Erin A.; Baird-Zars, Vivian M.; Barsness, Gregory W.; Chaudhry, Sunit-Preet; Chonde, Meshe D.; Cooper, Howard A.; Ginder, Curtis; Jentzer, Jacob C.; Kontos, Michael C.; Miller, P. Elliott; Newby, L. Kristin; O’Brien, Connor G.; Park, Jeong-Gun; Pierce, Matthew J.; Pisani, Barbara A.; Potter, Brian J.; Shah, Kevin S.; Teuteberg, Jeffrey J.; Katz, Jason N.; van Diepen, Sean; Morrow, David A.
Source
Circulation: Heart Failure. May 01, 2024 17(5):e011736-e011736
Subject
Language
English
ISSN
1941-3297
Abstract
BACKGROUND:: Associations of early changes in vasoactive support with cardiogenic shock (CS) mortality remain incompletely defined. METHODS:: The Critical Care Cardiology Trials Network is a multicenter registry of cardiac intensive care units. Patients admitted with CS (2018–2023) had vasoactive dosing assessed at 4 and 24 hours from cardiac intensive care unit admission and quantified by the vasoactive-inotropic score (VIS). Prognostic associations of VIS at both time points, as well as change in VIS from 4 to 24 hours, were examined. Interaction testing was performed based on mechanical circulatory support status. RESULTS:: Among 3665 patients, 82% had a change in VIS <10, with 7% and 11% having a ≥10-point increase and decrease from 4 to 24 hours, respectively. The 4 and 24-hour VIS were each associated with cardiac intensive care unit mortality (13%–45% and 11%–73% for VIS <10 to ≥40, respectively; Ptrend <0.0001 for each). Stratifying by the 4-hour VIS, changes in VIS from 4 to 24 hours had a graded association with mortality, ranging from a 2- to >4-fold difference in mortality comparing those with a ≥10-point increase to ≥10-point decrease in VIS (Ptrend <0.0001). The change in VIS alone provided good discrimination of cardiac intensive care unit mortality (C-statistic, 0.72 [95% CI, 0.70–0.75]) and improved discrimination of the 24-hour Sequential Organ Failure Assessment score (0.72 [95% CI, 0.69–0.74] to 0.76 [95% CI, 0.74–0.78]) and the clinician-assessed Society for Cardiovascular Angiography and Interventions shock stage (0.72 [95% CI, 0.70–0.74] to 0.77 [95% CI, 0.75–0.79]). Although present in both groups, the mortality risk associated with VIS was attenuated in patients managed with versus without mechanical circulatory support (odds ratio per 10-point higher 24-hour VIS, 1.36 [95% CI, 1.23–1.49] versus 1.84 [95% CI, 1.69–2.01]; Pinteraction <0.0001). CONCLUSIONS:: Early changes in the magnitude of vasoactive support in CS are associated with a gradient of risk for mortality. These data suggest that early VIS trajectory may improve CS prognostication, with the potential to be leveraged for clinical decision-making and research applications in CS.