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Effect of Admission and Onset Time on the Prognosis of Patients With Cardiogenic Shock
Michael Behnes1, Jonas Rusnak1, Sascha Egner-Walter1
1Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim.
Insights
Cardiogenic shock (CS) patients admitted during off-hours had a lower risk of 30-day mortality. In-hospital CS related to acute myocardial infarction (AMI) increased mortality risk, while overall place of onset did not significantly impact outcomes.
Area of Science:
- Cardiology
- Critical Care Medicine
- Clinical Research
Background:
- The patient demographic for cardiogenic shock (CS) has evolved, with an increasing prevalence of non-acute myocardial infarction (AMI) cases.
- The impact of CS onset location (in-hospital vs. out-of-hospital) and timing (on-hours vs. off-hours) on mortality remains under-investigated.
Purpose of the Study:
- To investigate the prognostic impact of CS onset location on 30-day all-cause mortality.
- To determine if the timing of out-of-hospital CS admission (on-hours vs. off-hours) influences mortality risk.
- To examine the association between AMI and non-AMI etiologies of CS and mortality outcomes.
Main Methods:
- Prospective monocentric registry of consecutive CS patients from 2019-2021.
- Kaplan-Meier analyses and univariable/multivariable Cox regression models were employed.
- Analysis stratified by place of onset, timing of onset, and presence/absence of AMI.
Main Results:
- No significant difference in 30-day mortality between primary (out-of-hospital) and secondary (in-hospital) CS overall (HR, 1.532; P = .06).
- Secondary in-hospital CS associated with AMI showed increased 30-day mortality risk (HR, 2.087; P = .02).
- Primary out-of-hospital CS admitted during off-hours demonstrated a significantly lower risk of 30-day mortality compared to on-hours admissions (HR, 0.497; P = .01).
Conclusions:
- The location of CS onset (primary vs. secondary) did not significantly alter 30-day mortality, but AMI-related secondary CS carried a higher risk.
- Out-of-hospital CS presenting during off-hours was associated with improved survival, irrespective of AMI.
- These findings highlight the importance of considering CS onset timing and etiology for risk stratification and management.
Background:
The spectrum of patients with cardiogenic shock (CS) has changed significantly over time. CS has become especially more common in the absence of acute myocardial infarction (AMI), while this subset of patients was typically excluded from recent studies. Furthermore the prognostic impact of onset time and onset place due to CS has rarely been investigated.
Research Question:
Do the place of CS onset (out-of-hospital, ie, primary CS vs in-hospital, ie, secondary CS) and the onset time of out-of-hospital CS (ie, on-hours vs off-hours admission) affect the risk of all-cause mortality at 30 days?
Study Design And Methods:
This prospective monocentric registry included consecutive patients with CS of any cause from 2019 until 2021. First, the prognostic impact of the place of CS onset (out-of-hospital, ie, primary CS vs during hospitalization, ie, secondary CS) was investigated. Thereafter, the prognostic impact of the onset time of out-of-hospital CS was investigated. Furthermore, the prognostic impact of causative AMI vs non-AMI was investigated. Statistical analyses included Kaplan-Meier analyses, and univariable and multivariable Cox regression analyses.
Results:
Two hundred seventy-three patients with CS were included prospectively (64% with primary out-of-hospital CS). The place of CS onset was not associated with increased risk of all-cause mortality within the entire study cohort (secondary in-hospital CS: hazard ratio [HR], 1.532; 95% CI, 0.990-2.371; P = .06). However, increased risk of 30-day all-cause mortality was seen in patients with AMI related secondary in-hospital CS (HR, 2.087; 95% CI, 1.126-3.868; P = .02). Furthermore, primary out-of-hospital CS admitted during off-hours was associated with lower risk of all-cause mortality compared to primary CS admitted during on-hours (HR, 0.497; 95% CI, 0.302-0.817; P = .01), irrespective of the presence or absence of AMI.
Interpretation:
Primary and secondary CS were associated with comparable, whereas primary out-of-hospital CS admitted during off-hours was associated with lower risk of all-cause mortality at 30 days.
Trial Registry:
ClinicalTrials.gov; No.: NCT05575856; URL: www.
Clinicaltrials:
gov.
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