Abstract 13382: Outcomes of Patients With Valvular Cardiogenic Shock Stratified by Treatment Strategy

Abstract

Background: No prior studies have compared the outcomes of patients with valvular cardiogenic shock (VCS) depending on the treatment received. Our study aimed to assess this. Methods: All patients admitted to Cleveland Clinic Cardiac Intensive Care Unit (CICU) between Jan 1 st , 2010, to Dec 31 st , 2021, with a diagnosis of cardiogenic shock (CS) were retrospectively identified through electronic medical records and confirmed via physician directed chart review. Patients with CS were subsequently categorized into those with valvular cardiogenic shock (VCS) and non-valvular CS depending on the primary etiology responsible for hemodynamic instability. The impact of treatment strategy on 1-year all-cause mortality in patients with VCS was assessed with Kaplan-Meier (KM) estimates. Results: Overall 511 patients were admitted to our CICU with VCS during the study period. Out of these patients, 188 patients (37%) underwent surgery, 76 patients (15%) underwent percutaneous structural intervention, and 247 patients (48) % underwent conservative management. Comparison of baseline characteristics (Table 1) revealed that patients with VCS who underwent surgical treatment were significantly younger (median age 64 yrs vs 72 and 76 yrs, p<0.001), and less likely to have coexisting comorbidities such as diabetes, dyslipidemia, chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD). KM survival analysis revealed that VCS patients who underwent conservative management had the highest all-cause mortality at 1 year, whereas those patients who underwent surgery had the lowest all-cause mortality at 1 year (p<0.001) (Figure 1). Conclusion: Patients with VCS remain a high-risk cohort who are most likely to be conservatively managed. Of the patients who received a specific therapy, surgical management was associated with the best outcomes. The impact of early intervention in patients with VCS needs to be further explored.