Clinical Outcomes Associated with Acute Mechanical Circulatory Support Utilization in Heart Failure Related Cardiogenic Shock

Abstract

<h3>Purpose</h3> We sought to define clinical, hemodynamic, metabolic, and both drug and device treatment parameters associated with clinical outcomes among heart failure patients presenting with cardiogenic shock (HF-CS) patients using data from the Cardiogenic Shock Working Group (CSWG) Registry. HF-CS is increasingly common however most studies have focused exclusively on acute myocardial infarction related CS. <h3>Methods</h3> HF-CS patients were selected from the multi-center CSWG registry were divided into 3 outcome cohorts assessed at hospital discharge: mortality, heart replacement therapy (HRT: durable VAD or heart transplant), or native heart survival (NHS: without heart replacement therapy). Clinical characteristics, hemodynamic and laboratory parameters, drug therapies, acute mechanical circulatory support device (AMCS) utilization, and Society of Cardiovascular Angiography and Intervention (SCAI) stages were compared across the 3 outcome cohorts. <h3>Results</h3> Of the 712 HF-CS patients identified, 180 (25.3%) died during their hospitalization, 277 (38.9%) underwent HRT, and 255 (35.8%) experienced NHS without HRT. Patients who died had the highest right atrial pressure and heart rate and the lowest mean arterial pressure of the 3 outcome groups (<i>p</i><0.01 for all). BiV congestion was most common among patients who died, while isolated left-ventricular congestion was most common among patients who underwent HRT. Lactate, BUN, serum creatinine, and AST were highest in HF-CS patients experiencing in-hospital death. In-hospital mortality increased with deteriorating SCAI stages (stage B: 0%, stage C: 10.7%, stage D: 29.4%, stage E: 54.5%, p <0.001), and with the use of AMCS devices (IABP: 23%, Impella: 45.3%, or ECMO: 54.7%, p<0.001). <h3>Conclusion</h3> In patients with HF-CS biventricular profile, surrogates of end-organ dysfunction, increased SCAI staging and the use of AMCS devices were all associated with a higher probability of in-hospital mortality.