Prognostic Impact of Admission Time in Infarct-Related Cardiogenic Shock: An ECLS-SHOCK Substudy
Tobias Schupp1, Holger Thiele2, Tienush Rassaf3
1Department of Cardiology, Angiology, Hemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Insights
Admission timing did not impact outcomes for acute myocardial infarction with cardiogenic shock (AMI-CS). Extracorporeal life support (ECLS) showed similar efficacy regardless of on-hours or off-hours hospital admission, with no significant difference in 30-day mortality.
Area of Science:
- Cardiology
- Critical Care Medicine
- Medical Technology
Background:
- Outcomes for acute myocardial infarction with cardiogenic shock (AMI-CS) can be influenced by hospital admission timing.
- The efficacy and safety of extracorporeal life support (ECLS) in AMI-CS patients may also vary based on admission time.
Purpose of the Study:
- To investigate the prognostic impact of on-hours versus off-hours hospital admission in patients with AMI-CS.
- To evaluate the efficacy of ECLS based on the timing of hospital admission in this patient cohort.
Main Methods:
- A substudy of the multicenter, randomized ECLS-SHOCK trial (2019-2022) included patients with AMI-CS.
- Patients were stratified into on-hours and off-hours admission groups.
- The primary endpoint was 30-day all-cause mortality, analyzed using Kaplan-Meier and logistic regression.
Main Results:
- Off-hours admission (48.4%) was not associated with increased 30-day mortality compared to on-hours admission (OR: 0.83; 95% CI: 0.56-1.22).
- ECLS demonstrated no significant prognostic impact on 30-day mortality for either on-hours (OR: 0.98; 95% CI: 0.58-1.68) or off-hours admission (OR: 0.94; 95% CI: 0.54-1.63).
- ECLS was linked to a higher risk of bleeding events, particularly in patients admitted during on-hours.
Conclusions:
- Hospital admission timing does not appear to affect prognosis in patients with AMI-CS.
- The therapeutic effect of ECLS is consistent for both on-hours and off-hours admissions in AMI-CS patients.
Background:
The outcomes of patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) and the efficacy and safety of extracorporeal life support (ECLS) may be affected by the timing of hospital admission.
Objectives:
The present ECLS-SHOCK substudy sought to investigate the prognostic impact of on-hours vs off-hours admission and the efficacy of ELCS according to the timing of hospital admission time in AMI-CS.
Methods:
Patients with AMI-CS enrolled in the multicenter, randomized ECLS-SHOCK trial from 2019 to 2022 were included. The prognosis of patients admitted during regular hours (ie, on-hours) was compared to patients admitted during off-hours. Thereafter, the prognostic impact of ECLS was investigated stratified by the timing of hospital admission. The primary endpoint was 30-day all-cause mortality. Statistical analyses included Kaplan-Meier, univariable, and multivariable logistic regression analyses.
Results:
Of 417 patients enrolled in the ECLS-SHOCK trial, 48.4% (n = 202) were admitted during off-hours. Patients admitted during off-hours were younger (median age = 62 years [Q1-Q3: 55-69 years] vs 63 years [Q1-Q3: 58-71 years]; P = 0.036) and more commonly treated using initial femoral access for coronary angiography (79.0% [n = 158/200] vs 67.9% [n = 146/215]; P = 0.011). However, off-hours admission was not associated with an increased risk of 30-day all-cause mortality (off-hours vs on-hours: 46.0% [n = 93/202] vs 50.7% [n = 109/215]; OR: 0.83; 95% CI: 0.56-1.22). Furthermore, ECLS had no prognostic impact on 30-day all-cause mortality in patients with AMI-CS admitted during on-hours (50.5% [n = 52/103] vs 50.9% [n = 57/112]; P = 0.95; OR: 0.98; 95% CI: 0.58-1.68) or in patients admitted during off-hours (45.3% [n = 48/106] vs 46.9% [n = 45/96]; P = 0.82; OR: 0.94; 95% CI: 0.54-1.63). Finally, ECLS was associated with an increased risk of bleeding events, especially in patients admitted during on-hours.
Conclusions:
The prognosis in AMI-CS was not affected by admission time with a similar effect of ECLS during on- and off-hours.
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