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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Differences between cardiogenic shock related to acute decompensated heart failure and acute myocardial infarction
Maurizio Bertaina1, Nuccia Morici2, Simone Frea3
1Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy.
Insights
Cardiogenic shock in acutely decompensated heart failure (ADHF-CS) patients present with more end-organ dysfunction and require longer hospital stays than those with acute myocardial infarction (AMI-CS). In-hospital mortality rates were similar for both conditions.
Area of Science:
- Cardiology
- Critical Care Medicine
- Heart Failure Research
Background:
- Cardiogenic shock (CS) is a life-threatening condition complicating both acute myocardial infarction (AMI-CS) and acutely decompensated heart failure (ADHF-CS).
- Understanding the distinct clinical profiles and outcomes of CS in these two patient populations is crucial for optimizing management strategies.
Purpose of the Study:
- To compare the clinical features, in-hospital course, and management of ADHF-CS versus AMI-CS.
- To identify differences in patient characteristics, treatment interventions, and outcomes between the two CS etiologies.
Main Methods:
- Analysis of data from the multicentre prospective Altshock-2 registry (March 2020 - February 2022).
- Comparison of 89 ADHF-CS patients with 101 AMI-CS patients.
- Assessment of clinical parameters, laboratory values, catecholamine use, mechanical support, length of stay, and mortality.
Main Results:
- ADHF-CS patients were younger but had higher creatinine, bilirubin, and central venous pressure.
- Epinephrine was more common in ADHF-CS, while norepinephrine was more common in AMI-CS.
- Temporary mechanical support was less frequent in ADHF-CS (46.6% vs. 75.8% in AMI-CS).
- ADHF-CS patients had longer hospital stays (28 vs. 17 days) and higher utilization of heart replacement therapies (transplant, LVAD).
- In-hospital mortality was similar (43.8% in ADHF-CS vs. 38.6% in AMI-CS).
Conclusions:
- ADHF-CS is characterized by greater end-organ and biventricular dysfunction, longer hospital stays, and increased need for heart replacement therapies compared to AMI-CS.
- Despite differing clinical presentations and interventions, in-hospital mortality rates for ADHF-CS and AMI-CS were comparable.
- These findings highlight the need for developing distinct management protocols tailored to the specific etiology of cardiogenic shock.
Aims:
The present analysis from the multicentre prospective Altshock-2 registry aims to better define clinical features, in-hospital course, and management of cardiogenic shock complicating acutely decompensated heart failure (ADHF-CS) as compared with that complicating acute myocardial infarction (AMI-CS).
Methods And Results:
All patients with AMI-CS or ADHF-CS enrolled in the Altshock-2 registry between March 2020 and February 2022 were selected. The primary objective was the characterization of ADHF-CS patients as compared with AMI-CS. In-hospital length of stay and mortality were secondary endpoints. One-hundred-ninety of the 238 CS patients enrolled in the aforementioned period were considered for the present analysis: 101 AMI-CS (80% ST-elevated myocardial infarction and 20% non-ST-elevated myocardial infarction) and 89 ADHF-CS. As compared with AMI-CS, ADHF-CS patients were younger [63 (IQR 59-76) vs. 67 (IQR 54-73) years, P = 0.01], but presented with higher creatinine [1.6 (IQR 1.0-2.6) vs. 1.2 (IQR 1.0-1.4) mg/dL, P < 0.001], bilirubin [1.3 (IQR 0.9-2.3) vs. 0.6 (IQR 0.4-1.1) mg/dL, P = 0.01], and central venous pressure values [14 mmHg (IQR 8-12) vs. 10 mmHg (IQR 7-14),P = 0.01]. Norepinephrine was the most common catecholamine used in AMI-CS (79.3%), whereas epinephrine was used more commonly in ADHF-CS (65.5%); 75.8% vs. 46.6% received a temporary mechanical support in AMI-CS and ADHF-CS, respectively (P < 0.001). Length of hospital stay was longer in the latter [28 (IQR 13-48) vs. 17 (IQR 9-29) days, P = 0.001]. Heart replacement therapies were more frequently used in the ADHF-CS group (heart transplantation 13.5% vs. 0% and left ventricular assist device 11% vs. 2%, P < 0.01 and 0.01, respectively). In-hospital mortality was 41.1% (38.6% AMI-CS vs. 43.8% ADHF-CS, P = 0.5).
Conclusions:
ADHF-CS is characterized by a higher prevalence of end-organ and biventricular dysfunction at presentation, a longer hospital length of stay, and higher need of heart replacement therapies when compared with AMI-CS. In-hospital mortality was similar between the two aetiologies. Our data warrant development of new management protocols focused on CS aetiology.
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