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Published on: June 12, 2021
Frequency and Impact of Bleeding on Outcome in Patients With Cardiogenic Shock
Anne Freund1, Alexander Jobs2, Philipp Lurz3
1Heart Center Leipzig at the University of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany; German Center for Cardiovascular Research, partner site Hamburg/Kiel/Lübeck, Lübeck, Germany; Leipzig Heart Institute, Leipzig, Germany.
Insights
Bleeding is common in infarct-related cardiogenic shock, affecting over 20% of patients. This increased bleeding risk is linked to higher mortality rates and requires careful management.
Area of Science:
- Cardiology
- Critical Care Medicine
- Clinical Research
Background:
- Acute myocardial infarction with cardiogenic shock necessitates early revascularization for improved survival.
- Invasive treatments and antithrombotic therapies increase bleeding risk in these critically ill patients.
- Limited prospective data exist on bleeding incidence, risk factors, and outcomes in cardiogenic shock.
Purpose of the Study:
- To determine the frequency, associated factors, and impact of bleeding in patients with infarct-related cardiogenic shock.
- To analyze bleeding events as a subanalysis of the CULPRIT-SHOCK trial.
Main Methods:
- A pre-defined subanalysis of 684 patients from the CULPRIT-SHOCK randomized trial.
- Examination of bleeding event distribution and comparison between patients with and without bleeding.
Main Results:
- 21.5% of patients experienced bleeding within 30 days, with 57% occurring in the first 2 days.
- Bleeding was associated with prolonged mechanical ventilation, catecholamine use, sepsis, arrhythmias, and peripheral ischemia.
- Mechanical support (ECMO/Impella) was a major risk factor for bleeding; bleeding significantly increased mortality (HR 2.11).
Conclusions:
- The risk of bleeding in infarct-related cardiogenic shock is substantial.
- Bleeding is a significant independent predictor of increased mortality in this patient population.
Objectives:
This study sought to determine frequency, associated factors, and impact of bleeding in infarct-related cardiogenic shock.
Background:
Early revascularization is associated with improved survival in patients with acute myocardial infarction complicated by cardiogenic shock. On the downside, invasive treatment and accompanying antithrombotic therapies are associated with an increased bleeding risk. Prospective data assessing the incidence, severity, risk factors, and prognostic implication of bleeding in patients with cardiogenic shock are scarce.
Methods:
As a pre-defined subanalysis of the CULPRIT-SHOCK (PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock) randomized trial, we examined distribution of bleeding events in 684 patients with infarct-related cardiogenic shock and compared patients with any bleeding to those without.
Results:
A total of 21.5% patients experienced at least 1 bleeding event until 30 days after randomization. The vast majority of bleeding (57%) occurred within the first 2 days of hospitalization. Patients with bleeding had prolonged catecholamine treatment and mechanical ventilation and there was a significant association with sepsis, peripheral ischemic complications, new atrial fibrillation, and ventricular fibrillation. In multivariable analysis, bleeding was associated with a significantly higher mortality (hazard ratio: 2.11; 95% confidence interval: 1.63 to 2.75; p < 0.0001). Treatment with active mechanical support by extracorporeal membrane oxygenation or Impella emerged as the major risk factor for bleeding.
Conclusions:
Risk of bleeding in infarct-related cardiogenic shock is high and associated with increased mortality.
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