Outcomes, Temporal Trends, and Resource Utilization in Ischemic versus Nonischemic Cardiogenic Shock

Area of Science:

• Cardiology
• Epidemiology
• Critical Care Medicine

Background:

• Cardiogenic shock (CS) presents significant morbidity and mortality.
• Identifying etiologies of CS is crucial for treatment, prognosis, and resource allocation.

Purpose of the Study:

• To investigate the epidemiology and clinical outcomes of ischemic (I-CS) versus non-ischemic (NI-CS) etiologies.
• To compare in-hospital mortality and secondary clinical outcomes between I-CS and NI-CS cohorts.

Main Methods:

• Utilized the National Inpatient Sample (2007-2018) to identify CS hospitalizations.
• Classified CS cases into I-CS and NI-CS cohorts based on etiology.
• Compared in-hospital mortality and clinical/procedural outcomes between the two groups.

Main Results:

• CS occurred in 557,860 hospitalizations; 84% were I-CS, 15.8% NI-CS.
• I-CS patients were older, more male, with more coronary artery disease risk factors.
• In-hospital mortality was higher for I-CS (32.2%) vs. NI-CS (29.5%).
• I-CS had higher rates of stroke, mechanical ventilation, arrhythmias, and vascular complications.
• NI-CS had higher rates of acute kidney and liver failure.
• Mechanical circulatory support use was higher in I-CS.

Conclusions:

• Ischemic CS is the predominant form, associated with greater mortality and resource utilization.
• Non-ischemic CS patients exhibit higher survival rates but increased end-organ dysfunction.
• Understanding CS etiology is vital for tailored management and improved patient outcomes.