Résumé
Epidemiologic data about cardiogenic shock (CS) are still poor and focused on ischemic CS, forgetting all part of the CS encountered in clinical practice.
FRENSHOCK registry (NCT02703038) was a large prospective multicenter registry of non-selected CS patients admitted in critical care units realized between April and October 2016 in France. Patients were included if they met the following three criteria:
– low cardiac output defined by SBP<90mmHg and/or the need of amines, or a low cardiac output defined by CI<2.2L/min/m2 (TTE or Swan–Ganz);
– elevation of left and/or right heart pressures defined by clinic/radiology/biology/echocardiography/Swan-Ganz;
– clinical and/or biological hypoperfusion.
In total, 772 patients were included in 48 centers (male 72%, mean age of 66y). Comorbidities associated previous coronary revascularization 26%, peripheral arterial disease 15%, renal failure 21%, COPD 6%, diabetes 28%, tobacco 28%, dyslipidemia 35% and hypertension 47%. 56% were known for previous cardiomyopathy (30% ischemic, 10% idiopathic, 8% valvular). CS etiology often associated several triggers: ischemic was retained for 36% (type 1 infarction 17%). Non-ischemic trigger factors were predominant (64%): supra-ventricular (13%) and ventricular arrythmia (13%), infection (12%), iatrogenic (6%), conductive disorders (2%), non-observance (4%), and others (14%). At admission median SBP was 101.2mmHg. Right heart failure signs were present in 49% and left signs in 72% (Killip IV 49%). Biological analysis found high lactate (3.0mmol/L), renal (eGFR 49.6ml/min) and hepatic alteration (ASAT 90.0UI/ml; PT 57.1%). Median LVEF was 26.3% and TAPSE 13.4mm. When realized (52%) coronarography was pathological in 81% (monotroncular 31%, bitroncular 35% and tritroncular 34%). A culprit lesion (79%) concern LVA 48%, RCA 23% and left main 15%.
CS presentation and etiology are heterogeneous with a predominance of non-ischemic CS in practice.