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Archives of cardiovascular diseases
Volume 112, n° 12
pages 738-747 (décembre 2019)
Doi : 10.1016/j.acvd.2019.04.004
Received : 19 February 2019 ;  accepted : 15 April 2019
Clinical research

Predictive factors for long-term mortality in miscellaneous cardiogenic shock: Protective role of beta-blockers at admission
Facteurs prédictifs de mortalité à long terme dans le choc cardiogénique toutes étiologies confondues : rôle protecteur des bêtabloquants à l’admission
 

Clément Delmas a, b, , Elisabeth Orloff a, Frédéric Bouisset a, Thomas Moine a, Barbara Citoni c, Caroline Biendel a, b, Jean Porterie d, Didier Carrié a, e, Michel Galinier a, f, Meyer Elbaz a, f, Olivier Lairez a, f, g, h
a Department of cardiology, Rangueil university hospital, 31059 Toulouse, France 
b Intensive cardiac care unit, Rangueil university hospital, 31059 Toulouse, France 
c Sapienza University of Rome, 00185 Rome, Italy 
d Department of cardiovascular surgery, Rangueil university hospital, 31059 Toulouse, France 
e Purpan medical school, university Paul Sabatier, 31300 Toulouse, France 
f Rangueil medical school, university Paul Sabatier, 31059 Toulouse, France 
g Cardiac imaging centre, Toulouse university hospital, 31059 Toulouse, France 
h Department of nuclear medicine, Rangueil university hospital, 31059 Toulouse, France 

Corresponding author at: Department of cardiology, Toulouse university hospital, 1, avenue Jean Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.Department of cardiology, Toulouse university hospital1, avenue Jean Poulhès, TSA 50032Toulouse cedex 931059France
Graphical abstract




The full text of this article is available in PDF format.
Summary
Background

Despite advances in intensive care medicine, management of cardiogenic shock (CS) remains difficult and imperfect, with high mortality rates, regardless of aetiology. Predictive data regarding long-term mortality rates in patients presenting CS are sparse.

Aim

To describe prognostic factors for long-term mortality in CS of different aetiologies.

Methods

Two hundred and seventy-five patients with CS admitted to our tertiary centre between January 2013 and December 2014 were reviewed retrospectively. Mortality was recorded in December 2016. A Cox proportional-hazards model was used to determine predictors of long-term mortality.

Results

Most patients were male (72.7%), with an average age of 64±16 years and a history of cardiomyopathy (63.5%), mainly ischaemic (42.3%). Leading causes of CS were myocardial infarction (35.3%), decompensated heart failure (34.2%) and cardiac arrest (20.7%). Long-term mortality was 62.5%. After multivariable analysis, previous use of beta-blockers (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.41–0.89; P =0.02) and coronary angiography exploration at admission (HR 0.57, 95% CI 0.38–0.86; P =0.02) were associated with a lower risk of long-term mortality. Conversely, age (HR 1.02 per year, 95% CI 1.01–1.04; P <0.001), catecholamine support (HR 1.45 for each additional agent, 95% CI 1.20–1.75; P <0.001) and renal replacement therapy (HR 1.66, 95% CI 1.09–2.55; P =0.02) were associated with an increased risk of long-term mortality.

Conclusions

Long-term mortality rates in CS remain high, reaching 60% at 1-year follow-up. Previous use of beta-blockers and coronary angiography exploration at admission were associated with better long-term survival, while age, renal replacement therapy and the use of catecholamines appeared to worsen the prognosis, and should lead to intensification of CS management.

The full text of this article is available in PDF format.
Résumé
Contexte

Malgré les progrès médicaux récents, la mortalité du choc cardiogénique (CC) reste élevée quelle qu’en soit l’étiologie.

But

Décrire les facteurs prédictifs de mortalité à long terme (LT) du CC toutes causes confondues.

Méthodes

Au total, 275 patients en CC admis entre 01/2013 et 12/2014 ont été rétrospectivement inclus. La mortalité a été recueillie en décembre 2016. Un modèle de risque proportionnel de Cox a été utilisé pour déterminer les variables indépendamment corrélées à la mortalité à LT.

Résultats

Cette étude a inclus majoritairement des hommes (72,7 %) d’un âge moyen de 64±16 ans. Les principales causes de CC étaient le syndrome coronaire aigu (35,3 %), la décompensation d’insuffisance cardiaque chronique (34,2 %) et le choc post arrêt cardiaque (20,7 %). La mortalité à LT était de 62,5 %. La prescription antérieure de bêtabloquants (HR 0,62, IC95 % 0,41–0,89 ; p =0,01) et la réalisation initiale d’une angiocoronarographie (HR 0,57, IC95 % 0,38–0,86 ; p =0,007) étaient des facteurs associés à la survie. L’âge (HR 1,02 par an, IC95 % 1,01–1,04 ; p <0,001), le nombre d’amines utilisées (HR 1,45 par unité, IC95 % 1,20–1,75 ; p <0,001) et le recours à l’épuration extra-rénale (hR 1,66, IC95 % 1,09–2,55 ; p =0,02) étaient associés à une surmortalité à LT.

Conclusions

La mortalité à LT du CC demeure importante et concerne plus de la moitié des patients. La prescription antérieure de bêtabloquants et la réalisation initiale d’une coronarographie sont associées à une meilleure survie à LT alors que l’âge, l’insuffisance rénale et l’utilisation d’amines semblent aggraver le pronostic.

The full text of this article is available in PDF format.

Keywords : Cardiogenic shock, Prognosis, Mortality

Mots clés : Choc cardiogénique, Pronostic, Mortalité

Abbreviations : ACS, CI, CS, HR, ICCU, MCS




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