Abstract
Aim: Evidence on non-ischemic cardiogenic shock (CS) is scarce. The aim of this study was to investigate differences in patient characteristics, use of treatments and outcomes in patients with non-ischemic vs. ischemic CS. Methods: Patients with CS admitted between October 2009 and October 2017 were identified and stratified as non-ischemic/ischemic CS based on the absence/presence of acute myocardial infarction. Logistic/Cox regression models were fitted to investigate the association between non-ischemic CS and patient characteristics, use of treatments and 30-day in-hospital mortality. Results: A total of 978 patients were enrolled in this study; median age was 70 (interquartile range 58, 79) years and 70% were male. Of these, 505 patients (52%) had non-ischemic CS. Patients with non-ischemic CS were more likely to be younger and female; were less likely to be active smokers, to have diabetes or decreased renal function, but more likely to have a history of myocardial infarction; and they were more likely to present with unfavorable hemodynamics and with mechanical ventilation. Regarding treatments, patients with non-ischemic CS were more likely to be treated with catecholamines, but less likely to be treated with extracorporeal membrane oxygenation or percutaneous left-ventricular assist devices. After adjustment for multiple relevant confounders, non-ischemic CS was associated with a significant increase in the risk of 30-day in-hospital mortality (hazard ratio 1.14, 95% confidence interval 1.04–1.24, p < 0.01). Conclusion: In this large study, non-ischemic CS accounted for more than 50% of all CS cases. Non-ischemic CS was not only associated with relevant differences in patient characteristics and use of treatments, but also with a worse prognosis. These findings highlight the need for effective treatment strategies for patients with non-ischemic CS.
Highlights
Cardiogenic shock (CS) originates in a state of severely reduced cardiac output, which leads to impaired end-organ perfusion and multi-organ failure [1]
Ischemic cardiogenic shock (CS) was adjudicated if acute myocardial infarction, either with or without ST-segment elevation, was the main reason for CS/admission; non-ischemic CS was adjudicated in all other cases
There were significant and relevant differences the in use of treatments, as patients with non-ischemic CS were more likely to be treated with catecholamines, but less likely to be treated with mechanical circulatory support
Summary
Cardiogenic shock (CS) originates in a state of severely reduced cardiac output, which leads to impaired end-organ perfusion and multi-organ failure [1]. Aside from early revascularization for patients with ischemic CS (e.g., CS due to acute myocardial infarction), there is no treatment which has shown to improve outcomes in CS [3,4]. Patient characteristics might differ in patients with ischemic vs non-ischemic CS This would have direct implications for diagnostic algorithms, which might have to account for different CS sub-types. There is as yet no evidence-based therapy targeting the severe myocardial dysfunction which can be applied in non-ischemic CS [2]. This limits the available options in the management of non-ischemic CS. The only remaining option currently is to bridge the patient until stabilization of native cardiac function or until heart transplantation or durable mechanical circulatory support implantation [2]
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