Abstract 14677: Therapeutic Outcomes in Concomitant Cardiogenic Shock and Severe Aortic Stenosis: Insights From the National Inpatient Sample

Abstract

Introduction: Cardiogenic shock (CS) in patients with concomitant severe aortic stenosis (AS) is a critical combination of pathologies that has been associated with a 43% to 77% in-hospital mortality. There is scant data regarding outcomes after medical management (MM), transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in this high risk population. Methods: The National Inpatient Sample was queried from 2011-2019 for relevant ICD-9 and ICD-10 codes to identify patients with AS and CS who underwent MM, TAVR or SAVR. Binary logistic regression was used to adjust outcomes for significantly different baseline characteristics. Results: We identified a weighted sample of 4,663,000 patients with AS, of which 26,101 had a concurrent diagnosis of CS and did not meet exclusion criteria. Medical management was associated with increased mortality compared to treatment with TAVR or SAVR (aOR 2.231, 95% CI 2.032-2.448, p<0.001). SAVR was associated with decreased mortality when compared to TAVR, although the difference was not statistically significant. Patients that underwent intervention, and specifically SAVR, had lower odds of cardiac arrest than patients that underwent medical management (SAVR aOR 0.514, 95% CI 0.386- 0.685, p<0.001, TAVR aOR 1.946, 95% CI 1.461-2.592, p<0.001). Medical management was associated with decreased risk of complete heart block (aOR 0.402, 95% CI 0.341-0.473, p<0.001), length of stay (8.4±9.9 days versus 9.6±8.5 for TAVR and 11.4±9.7 for SAVR, p<0.001) and cost of stay ($151,605±200,268 versus $352,936 ±297,495 for TAVR and $325,485 ±281,422 for SAVR, p<0.001). Conclusions: Patients with concomitant CS and severe AS have increased mortality with MM as compared to patients that undergo TAVR or SAVR, however there is no significant difference between TAVR and SAVR mortality despite SAVR patients generally having a lower incidence of comorbidities. These patients may benefit from AVR as opposed to MM.