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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
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Influence of cardiac arrest and SCAI shock stage on cardiac intensive care unit mortality

Jacob C Jentzer1,2, Timothy D Henry3, Gregory W Barsness1

  • 1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|March 18, 2020
PubMed

Insights

Cardiac arrest (CA) with shock increases mortality risk in cardiac intensive care unit (CICU) patients. Non-ventricular fibrillation (VF) CA is associated with higher mortality than VF CA, regardless of shock severity.

Area of Science:

  • Cardiology
  • Intensive Care Medicine
  • Clinical Outcomes

Background:

  • Patients with cardiac arrest (CA) and shock face elevated mortality risks.
  • Shock severity alone does not fully capture mortality risk in these patients.
  • The specific role of ventricular fibrillation (VF) in modifying CA-related mortality in cardiac intensive care units (CICUs) is unclear.

Purpose of the Study:

  • To investigate if the presence of VF influences the relationship between CA and mortality in CICU patients.
  • To analyze how different CA rhythms (VF vs. non-VF) impact outcomes within varying shock severities.

Main Methods:

  • Retrospective analysis of 9,898 unique Mayo Clinic CICU patients (2007-2015).
  • Classification of patients based on Society for Cardiovascular Angiography and Intervention (SCAI) shock stages (A-E) at admission.
  • Stratification of hospital mortality by the presence of CA, VF CA, or non-VF CA within each SCAI shock stage.

Main Results:

  • Hospital mortality was significantly higher in patients with CA (34%) versus without CA (6%).
  • Non-VF CA demonstrated higher hospital mortality (44%) compared to VF CA (25%).
  • After adjustment, non-VF CA was linked to increased mortality across SCAI stages (except E), while VF CA was not.

Conclusions:

  • The type of cardiac arrest rhythm (VF vs. non-VF) significantly modifies the association between CA and mortality in CICU patients.
  • Future outcome studies in cardiogenic shock must consider the impact of CA rhythm.
  • Accounting for CA rhythm provides a more nuanced understanding of mortality risk in critically ill cardiac patients.
Abstract

Keywords:
cardiac arrestcardiac intensive care unitcardiogenic shockmortalityshockventricular fibrillation

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