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Publications

Journal Article Epublish

PubMed: 42712883 DOI: 10.1093/ehjopen/oeag126

Vasoactive intensity predicts mortality beyond SCAI staging in cardiogenic shock.

Eur Heart J Open 6(5):oeag126

Authors: Christophe Beyls, Nicolas Mollet, Nathan Helstroffer, Osama Abou-Arab, Yazine Mahjoub, Bélaïd Bouhemad, François Roubille, Pierre-Grégoire Guinot

Affiliations

  • Department of Anesthesiology and Intensive Care, Amiens University Hospital, 1 rond point christian Cabrol, AMIENS 80000, France.
  • UR UPJV 7518 SSPC (Simplification of Care of Complex Surgical Patients) Research Unit, University of Picardie Jules Verne, 1 rond point christian Cabrol, AMIENS 80000, France.
  • University of Burgundy and Franche-Comté, LNC UMR1231, 7 Bd Jeanne d'Arc, Dijon 21000, France.
  • INSERM, LNC UMR1231, 7 Bd Jeanne d'Arc, Dijon 21000, France.
  • FCS Bourgogne-Franche Comté, LipSTIC LabEx, 7 Bd Jeanne d'Arc, Dijon 21000, France.
  • PhyMedExp, INSERM, CNRS, Cardiology Department, INI-CRT, University of Montpellier, 2 rue de l'Ecole de Médecine - 34000 MONTPELLIER, France.
  • Department of Anesthesiology and Intensive Care, Dijon University Hospital, 1 Rue du Professeur Marion, Dijon F-21000, France.

Abstract

AIMS

Cardiogenic shock (CS) remains associated with high mortality. Severity is traditionally stratified by the Society for Cardiovascular Angiography and Interventions (SCAI) staging system despite substantial heterogeneity within stages. Whether vasoactive therapy intensity or combination provides additional prognostic information beyond SCAI staging remains unknown. This study assessed whether vasoactive support intensity, quantified by the vasoactive-inotropic score (VIS), improves mortality prediction beyond SCAI staging.

METHODS AND RESULTS

In this retrospective bicentric cohort, consecutive adults admitted for CS between 2018 and 2023 were included. The VIS was calculated. The primary outcome was 90-day mortality. Multivariable logistic regression models adjusted for baseline severity assessed interactions with SCAI stage and the incremental prognostic value of VIS using nested models. Among 1167 patients, 90-day mortality increased across SCAI stages C, D, and E (20.1%, 27.4%, and 45.6%; P < 0.001, respectively), with substantial heterogeneity within stages. In stage C, dobutamine alone was associated with lower mortality than norepinephrine alone [OR = 0.25 (0.09-0.74); P = 0.009]; in stage E, dobutamine plus norepinephrine was associated with higher mortality [OR = 2.39 (1.07-5.36); P = 0.028]. The number of vasoactive agents was associated with mortality (OR = 1.27 per additional agent; P = 0.041) but proved a crude marker, providing only marginal incremental discrimination (R 2 = 0.233; Δ = +0.011), with its prognostic information fully captured by VIS (R 2 = 0.286 vs. 0.287 with and without number of agents). Adding SCAI stage minimally improved discrimination (R 2 = 0.222-0.226; Δ = +0.004), whereas VIS substantially improved model performance (R 2 = 0.286; Δ = +0.060; P < 0.001).

CONCLUSION

Vasoactive intensity quantified by the VIS improved 90-day mortality prediction beyond SCAI staging and the simple count of vasoactive drugs, providing incremental prognostic information beyond SCAI staging.

MeSH

Mortality, Shock, Cardiogenic, Norepinephrine, Dobutamine