Abstract
BackgroundThis single-center observational study assessed the impact of age, sex, and body mass index (BMI) in patients with cardiogenic shock on temporary mechanical circulatory support. MethodsAll adult patients admitted to the Cleveland Clinic main campus Cardiac Intensive Care Unit (CICU) between Dec 1st, 2015, to Dec 31st, 2019, CICU with cardiogenic shock necessitating MCS with Intra-Aortic Balloon Pump (IABP), Impella or Venous Arterial- Extra Corporeal Membrane Oxygenation (VA- ECMO) were retrospectively analyzed for this study. Baseline characteristics and 30-day outcomes were collected via physician directed chart review. The impact of age, sex, and BMI on 30-day mortality was assessed using multivariable logistic regression. Kaplan Meier survival curves were used to analyze the survival difference in specific subsets. ResultsA total of 393 patients with CS on temporary MCS were admitted to our CICU during the study period. The median age of out cohort was 63 years (IQR 54-70yrs), median BMI was 28.50 kg/m2 (IQR 24.62-29.72) and 70% (n=276) were males. 22 patients >80 years had received MCS compared to 372 patients<80 years. Patients>80 years on MCS had significantly higher 30-day mortality compared to those less than 80 years (81.8% vs 49.3%, p=0.006). Upon stratifying patients by BMI, 161 patients (41%) were found to have BMI≥30 kg/m2 whereas 232 patients (59%) had BMI<30 kg/m2. Comparison of 30-day mortality revealed that patients with BMI≥30 did significantly worse than patients with BMI<30 (59.6% vs 45.3%, p=0.007). There was no difference in 30-day mortality between men and women. On multivariable logistic regression both age and BMI had a positive linear relationship with adjusted 30-day mortality whereas sex did not have a major effect. ConclusionsAdvanced age and higher BMI are independently associated with worse outcomes in patients with CS on MCS. Utilizing a strict selection criterion for patients in CS is pertinent to derive the maximum benefit from advanced mechanical support.
Published Version
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