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Clinical characteristics and prognostic factors in acute coronary syndrome patients complicated with cardiogenic shock in Japan: analysis from the Japanese Circulation Society Cardiovascular Shock Registry

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Abstract

Cardiogenic shock frequently leads to death even with intensive treatment. Although the leading cause of cardiogenic shock is acute coronary syndrome (ACS), the clinical characteristics and the prognosis of ACS with cardiogenic shock in the present era still remain to be elucidated. We analyzed clinical characteristics and predictors of 30-day mortality in ACS with cardiogenic shock in Japan. The Japanese Circulation Society Cardiovascular Shock registry was a prospective, observational, multicenter, cohort study. Between May 2012 and June 2014, 495 ACS patients with cardiogenic shock were analyzed. The primary endpoint was 30-day all-cause mortality. The median [interquartile range; IQR] age was 71.0 [63.0, 80.0] years. The median [IQR] value of systolic blood pressure (SBP) and heart rate were 75.0 [50.0, 86.5] mm Hg and 65.0 [38.0, 98.0] bpm, respectively. Multivariable analysis showed an odds ratio (OR) of 4.76 (confidence intervals; CI 1.97–11.5, p < 0.001) in the lowest SBP category (< 50 mm Hg) for SBP ≥ 90 mm Hg. Moreover, age per 10 years increase (OR 1.38, CI 1.18–1.61, p = 0.002), deep coma (OR 3.49, CI 1.94–6.34, p < 0.001), congestive heart failure (OR 3.81, CI 2.04–7.59, p < 0.001) and left main trunk disease (LMTD) (OR 2.81, CI 1.55–5.10, p < 0.001) were independent predictors. Severe hypotension, older age, deep coma, congestive heart failure, and LMTD were independent unfavorable factors in ACS complicated by cardiogenic shock in Japan. A prompt assessment of high-risk patients referring to those predictors in emergency room could lead to appropriate treatment without delay.

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References

  1. Reynolds HR, Hochman JS (2008) Cardiogenic shock: current concepts and improving outcomes. Circulation 117:686–697

    Article  PubMed  Google Scholar 

  2. Jeger RV, Radovanovic D, Hunziker PR, Pfisterer ME, Stauffer JC, Erne P, Urban P, Plus Registry Investigators AMIS (2008) Ten-year trends in the incidence and treatment of cardiogenic shock. Ann Intern Med 149:618–626

    Article  PubMed  Google Scholar 

  3. Redfors B, Angerås O, Råmunddal T, Dworeck C, Haraldsson I, Ioanes D, Petursson P, Libungan B, Odenstedt J, Stewart J, Lodin E, Wahlin M, Albertsson P, Matejka G, Omerovic E (2015) 17-year trends in incidence and prognosis of cardiogenic shock in patients with acute myocardial infarction in western Sweden. Int J Cardiol 185:256–262

    Article  CAS  PubMed  Google Scholar 

  4. Awad HH, Anderson FA Jr, Gore JM, Goodman SG, Goldberg RJ (2012) Cardiogenic shock complicating acute coronary syndromes: insights from the Global Registry of Acute Coronary Events. Am Heart J 163:963–971

    Article  PubMed  Google Scholar 

  5. Harjola VP, Lassus J, Sionis A, Køber L, Tarvasmäki T, Spinar J, Parissis J, Banaszewski M, Silva-Cardoso J, Carubelli V, Di Somma S, Tolppanen H, Zeymer U, Thiele H, Nieminen MS, Mebazaa A, CardShock Study Investigators; GREAT Network (2015) Clinical picture and risk prediction of short-term mortality in cardiogenic shock. Eur J Heart Fail 17:501–509

    Article  PubMed  Google Scholar 

  6. Kunadian V, Qiu W, Ludman P, Redwood S, Curzen N, Stables R, Gunn J, Gershlick A, National Institute for Cardiovascular Outcomes Research (2014) Outcomes in patients with cardiogenic shock following percutaneous coronary intervention in the contemporary era: an analysis from the BCIS database (British Cardiovascular Intervention Society). JACC Cardiovasc Interv 7:1374–1385

    Article  PubMed  Google Scholar 

  7. Granger CB, Goldberg RJ, Dabbous O, Pieper KS, Eagle KA, Cannon CP, Van De Werf F, Avezum A, Goodman SG, Flather MD, Fox KA, Global Registry of Acute Coronary Events Investigators (2003) Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med 163:2345–2353

    Article  PubMed  Google Scholar 

  8. Sleeper LA, Reynolds HR, White HD, Webb JG, Dzavík V, Hochman JS (2010) A severity scoring system for risk assessment of patients with cardiogenic shock: a report from the SHOCK Trial and Registry. Am Heart J 160:443–450

    Article  PubMed  PubMed Central  Google Scholar 

  9. Poss J, Köster J, Fuernau G, Eitel I, de Waha S, Ouarrak T, Lassus J, Harjola VP, Zeymer U, Thiele H, Desch S (2017) Risk stratification for patients in cardiogenic shock after acute myocardial infarction. J Am Coll Cardiol 69:1913–1920

    Article  PubMed  Google Scholar 

  10. Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A (2014) 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 35:2541–2619

    Article  PubMed  Google Scholar 

  11. Miura T, Miyashita Y, Motoki H, Shimada K, Kobayashi M, Nakajima H, Kimura H, Akanuma H, Mawatari E, Sato T, Hotta S, Kamiyoshi Y, Maruyama T, Watanabe N, Eisawa T, Aso S, Uchikawa S, Hashizume N, Sekimura N, Morita T, Ebisawa S, Izawa A, Tomita T, Koyama J, Ikeda U (2014) In-hospital clinical outcomes of elderly patients (≥ 80 years) undergoing percutaneous coronary intervention. Circ J 78:1097–1103

    Article  PubMed  Google Scholar 

  12. Inoue T, Kuwabara H, Fushimi K (2017) Regional variation in the use of percutaneous coronary intervention in Japan. Circ J 81:195–198

    Article  PubMed  Google Scholar 

  13. Ueki Y, Mohri M, Matoba T, Tsujita Y, Yamasaki M, Tachibana E, Yonemoto N, Nagao K (2016) Characteristics and predictors of mortality in patients with cardiovascular shock in Japan—results from the Japanese Circulation Society Cardiovascular Shock Registry. Circ J 80:852–859

    Article  PubMed  Google Scholar 

  14. Amsterdam EA, Wenger NK, Brindis RG, Casey DE Jr, Ganiats TG, Holmes DR Jr, Jaffe AS, Jneid H, Kelly RF, Kontos MC, Levine GN, Liebson PR, Mukherjee D, Peterson ED, Sabatine MS, Smalling RW, Zieman SJ (2014) 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 130:2354–2394

    Article  Google Scholar 

  15. McKee PA, Castelli WP, McNamara PM, Kannel WB (1971) The natural history of congestive heart failure: the Framingham study. N Engl J Med 285:1441–1446

    Article  CAS  PubMed  Google Scholar 

  16. Killip T 3rd, Kimball JT (1967) Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol 20:457–464

    Article  PubMed  Google Scholar 

  17. Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, Buller CE, Jacobs AK, Slater JN, Col J, McKinlay SM, LeJemtel TH (1999) Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med 341:625–634

    Article  CAS  PubMed  Google Scholar 

  18. Hochman JS, Sleeper LA, White HD, Dzavik V, Wong SC, Menon V, Webb JG, Steingart R, Picard MH, Menegus MA, Boland J, Sanborn T, Buller CE, Modur S, Forman R, Desvigne-Nickens P, Jacobs AK, Slater JN, LeJemtel TH, Investigators SHOCK (2001) One-year survival following early revascularization for cardiogenic shock. JAMA 285:190–192

    Article  CAS  PubMed  Google Scholar 

  19. O’Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX, Anderson JL, Jacobs AK, Halperin JL, Albert NM, Brindis RG, Creager MA, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Kushner FG, Ohman EM, Stevenson WG, Yancy CW, American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines (2013) 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 127:362–425

    Article  Google Scholar 

  20. Allgower M, Burri C (1967) Shock index. Dtsch Med Wochenschr 92:1947–1950

    Article  CAS  Google Scholar 

  21. Jensen MT, Pereira M, Araujo C, Malmivaara A, Ferrieres J, Degano IR, Kirchberger I, Farmakis D, Garel P, Torre M, Marrugat J, Azevedo A (2018) Heart rate at admission is a predictor of in-hospital mortality in patients with acute coronary syndromes: results from 58 European hospitals: the European Hospital Benchmarking by outcomes in acute coronary syndrome processes study. Eur Heart J Acute Cardiovasc Care 7:149–157

    Article  PubMed  Google Scholar 

  22. Lettieri C, Savonitto S, De Servi S, Guagliumi G, Belli G, Repetto A, Piccaluga E, Politi A, Ettori F, Castiglioni B, Fabbiocchi F, De Cesare N, Sangiorgi G, Musumeci G, Onofri M, D’Urbano M, Pirelli S, Zanini R, Klugmann S, LombardIMA Study Group (2009) Emergency percutaneous coronary intervention in patients with ST-elevation myocardial infarction complicated by out-of-hospital cardiac arrest: early and medium-term outcome. Am Heart J 157:569–575

    Article  PubMed  Google Scholar 

  23. McNamara RL, Kennedy KF, Cohen DJ, Diercks DB, Moscucci M, Ramee S, Wang TY, Connolly T, Spertus JA (2016) Predicting in-hospital mortality in patients with acute myocardial infarction. J Am Coll Cardiol 68:626–635

    Article  PubMed  Google Scholar 

  24. Zeymer U, Vogt A, Zahn R, Weber MA, Tebbe U, Gottwik M, Bonzel T, Senges J, Neuhaus KL, Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK) (2004) Predictors of in-hospital mortality in 1333 patients with acute myocardial infarction complicated by cardiogenic shock treated with primary percutaneous coronary intervention (PCI); Results of the primary PCI registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK). Eur Heart J 25:322–328

    Article  PubMed  Google Scholar 

  25. Geri G, Dumas F, Bougouin W, Varenne O, Daviaud F, Pène F, Lamhaut L, Chiche JD, Spaulding C, Mira JP, Empana JP, Cariou A (2015) Immediate percutaneous coronary intervention is associated with improved short- and long-term survival after out-of-hospital cardiac arrest. Circ Cardiovasc Interv. https://doi.org/10.1161/circinterventions.114.002303

    Article  PubMed  Google Scholar 

  26. D’Souza M, Sarkisian L, Saaby L, Poulsen TS, Gerke O, Larsen TB, Diederichsen AC, Jangaard N, Diederichsen SZ, Hosbond S, Hove J, Thygesen K, Mickley H (2015) Diagnosis of unstable angina pectoris has declined markedly with the advent of more sensitive troponin assays. Am J Med 128:852–860

    Article  PubMed  Google Scholar 

  27. Webb JG, Lowe AM, Sanborn TA, White HD, Sleeper LA, Carere RG, Buller CE, Wong SC, Boland J, Dzavik V, Porway M, Pate G, Bergman G, Hochman JS, Investigators SHOCK (2003) Percutaneous coronary intervention for cardiogenic shock in the SHOCK trial. J Am Coll Cardiol 42:1380–1386

    Article  PubMed  Google Scholar 

  28. Mehta RH, Ou F-S, Peterson ED, Shaw RE, Hillegass WB Jr, Rumsfeld JS, Roe MT, American College of Cardiology–National Cardiovascular Database Registry Investigators (2009) Clinical significance of post-procedural TIMI flow in patients with cardiogenic shock undergoing primary percutaneous coronary intervention. JACC Cardiovasc Interv 2:56–64

    Article  PubMed  Google Scholar 

  29. El-Hayek GE, Gershlick AH, Hong MK, Casso Dominguez A, Banning A, Afshar AE, Herzog E, Tamis-Holland JE (2015) Meta-analysis of randomized controlled trials comparing multivessel versus culprit-only revascularization for patients with ST-segment elevation myocardial infarction and multivessel disease undergoing primary percutaneous coronary intervention. Am J Cardiol 115:1481–1486

    Article  PubMed  Google Scholar 

  30. Thiele H, Akin I, Sandri M, de Waha-Thiele S, Meyer-Saraei R, Fuernau G, Eitel I, Nordbeck P, Geisler T, Landmesser U, Skurk C, Fach A, Jobs A, Lapp H, Piek JJ, Noc M, Goslar T, Felix SB, Maier LS, Stepinska J, Oldroyd K, Serpytis P, Montalescot G, Barthelemy O, Huber K, Windecker S, Hunziker L, Savonitto S, Torremante P, Vrints C, Schneider S, Zeymer U, Desch S (2018) CULPRIT-SHOCK investigators. N Engl J Med 379:1699–1710

    Article  PubMed  Google Scholar 

  31. Kitamura T, Iwami T, Kawamura T, Nagao K, Tanaka H, Hiraide A (2010) Nationwide public-access defibrillation in Japan. N Engl J Med 362:994–1004

    Article  CAS  PubMed  Google Scholar 

  32. Nakamura F, Nakai M (2017) Prediction models—why are they used or not used? Circ J 81:1766–1767

    Article  PubMed  Google Scholar 

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Acknowledgements

Conception and design: TM, MM, YU, YT, MY, ET, NY, KN; data acquisition: TM, MM, YU, YT, MY, NT, YH, MF, KH, RF, SS, HM; data analysis and interpretation: KS, TM; drafting and finalizing the article: KS, TM; revision of the article critically for important intellectual content: MM, YU, YT, MY, ET, NY, KN. We thank Makoto Kobayashi for the administration work done for the subcommittee of the Japanese Circulation Society Cardiovascular Shock registry and the staff of the following hospitals for data collection. Asahikawa Medical University Hospital, Chikamori Hospital, Dokkyo Medical University, Ebara Hospital, Ehime University Hospital, Fuchu Hospital, Fukuoka University Hospital, Fukushima Medical University Aizu Medical Center, Harasanshin Hospital, Hirosaki University School of Medicine and Hospital, Hiroshima Prefectural Hospital, Hokkaido Cardiovascular Hospital, Hyogo Prefectural Amagasaki General Medical Center, International Goodwill Hospital, Itami City Hospital, IUHW Atami Hospital, JA Hiroshima General Hospital, Japanese Red Cross Kyoto Daini Hospital, Japanese Red Cross Nagoya Daiichi Hospital, Japanese Red Cross Okayama Hospital, JCHO Kyushu Hospital, JCHO Yokohama Chuo Hospital, Jichi Medical University Hospital, Joetsu General Hospital, Juntendo University Shizuoka Hospital, Kashiwa Municipal Hospital, Kawaguchi Municipal Medical Center, Kawasaki Hospital, Kita-Harima Medical Center, Kitano Hospital, Kouseikai Takai Hospital, Kumamoto University Hospital, Kyorin University Hospital, Kyushu University Hospital, Matsue City Hospital, Matsue Red Cross Hospital, Matsumoto Kyoritsu Hospital, Mito Medical Center, Musashino Red Cross Hospital, Nagasaki University Hospital, Nagoya University Graduate School of Medicine, National Hospital Organization Kanazawa Medical Center, National Hospital Organization Kyoto Medical Center, Nihon University Hospital, Nippon Medical School Chiba Hokusoh Hospital, Nishitokyo Central General Hospital, NTT Medical Center Tokyo, Osaka Police Hospital, Osaka Saiseikai Senri Hospital, Osaka University Hospital, Otemae Hospital, Saiseikai Futsukaichi Hospital, Saiseikai Hita Hospital, Saiseikai Kawaguchi General Hospital, Saiseikai Kumamoto Hospital, Saiseikai Niigata Daini Hospital, Saiseikai Yokohamashi Nanbu Hospital, Saitama Medical University International Medical Center, Sakaide City Hospital, Sakakibara Heart Institute, Sasebo City General Hospital, Shiga University of Medical Science Hospital, Shinshu University Hospital, Steel Memorial Muroran Hospital, Sumitomo Hospital, Tohoku Rosai Hospital, Tokai University Hachioji Hospital, Tokushima University Hospital, Tokyo Dental College Ichikawa General Hospital, Tokyo Medical and Dental University Hospital of Medicine, Tokyo Medical University Hospital, Tokyo Metropolitan Tama Medical Center, Tokyo Metropolitan Hiroo Hospital, Toyonaka Municipal Hospital, Tsukazaki Hospital, Yamaguchi Grand Medical Center, Yamaguchi Rosai Hospital, Yokohama City University Hospital, Yokohama Municipal Citizen’s Hospital, Yokohama Rosai Hospital, and Yokohama City University Medical Center (in alphabetical order).

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Authors and Affiliations

  1. JCS Shock Registry Scientific Committee, Tokyo, Japan

    Kazuo Sakamoto, Tetsuya Matoba, Masahiro Mohri, Yasushi Ueki, Yasuyuki Tsujita, Masao Yamasaki, Nobuhiro Tanaka, Yohei Hokama, Motoki Fukutomi, Katsutaka Hashiba, Rei Fukuhara, Satoru Suwa, Hirohide Matsuura, Eizo Tachibana, Naohiro Yonemoto & Ken Nagao

  2. Department of Cardiovascular Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Kazuo Sakamoto & Tetsuya Matoba

  3. Department of Cardiology, Japan Community Healthcare Organization Kyushu Hospital, Kitakyushu, Japan

    Masahiro Mohri

  4. Emergency and Critical Care Center, Shinshu University School of Medicine, Matsumoto, Japan

    Yasushi Ueki

  5. Department of Critical and Intensive Care Medicine, Shiga University of Medical Science, Otsu, Japan

    Yasuyuki Tsujita

  6. Department of Cardiovascular Medicine, NTT Medical Center, Tokyo, Japan

    Masao Yamasaki

  7. Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan

    Nobuhiro Tanaka & Yohei Hokama

  8. Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan

    Motoki Fukutomi

  9. Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan

    Katsutaka Hashiba

  10. Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan

    Rei Fukuhara

  11. Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Japan

    Satoru Suwa

  12. Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan

    Hirohide Matsuura

  13. Department of Cardiology, Kawaguchi Municipal Medical Center, Kawaguchi, Japan

    Eizo Tachibana

  14. Department of Biostatistics, Kyoto University School of Public Health, Kyoto, Japan

    Naohiro Yonemoto

  15. Cardiovascular Center, Nihon University Hospital, Tokyo, Japan

    Ken Nagao

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  1. Kazuo Sakamoto
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  15. Naohiro Yonemoto
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Correspondence to Tetsuya Matoba.

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Sakamoto, K., Matoba, T., Mohri, M. et al. Clinical characteristics and prognostic factors in acute coronary syndrome patients complicated with cardiogenic shock in Japan: analysis from the Japanese Circulation Society Cardiovascular Shock Registry. Heart Vessels 34, 1241–1249 (2019). https://doi.org/10.1007/s00380-019-01354-9

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