Early Mechanical Circulatory Support is Associated with Improved Outcomes in Cardiogenic Shock Due to End-Stage Heart Failure

Abstract

Data on mechanical circulatory support (MCS) in patients with cardiogenic shock (CS) due to end-stage heart failure (ESHF) are limited. We hypothesised that earlier intervention with MCS in patients with CS due to ESHF at INTERMACS class 2 compared to INTERMACS 1 is associated with less organ dysfunction and better survival . Retrospective analysis of prospectively collected data (November 2014 to July 2019) from a single centre. ESHF was defined by a diagnosis of HF prior to presentation with CS. Other causes of CS (eg: myocardial infarction) were excluded. Outcome was survival at 90 days. We included 60 patients with CS due to ESHF Differences in baseline characteristics were consistent with the different INTERMACS profiles [TABLE]. The primary and subsequent MCS modalities are shown in FIGURE 1. The duration of MCS was similar between INTERMACS 1 and 2 patients (15 (10-33) vs 14 (7-23) days, p=0.269). Compared to INTERMACS 2, INTERMACS 1 patients had more organ dysfunction on support and significantly lower 90-day survival (p=0.020 [FIGURE 2]. Earlier MCS in patients with CS due to ESHF at INTERMACS 2 was associated with less organ dysfunction and better 90-day survival compared to INTERMACS 1 patients.