Incidence Of Cardiogenic Shock Research Articles

Outcomes of pericardial complications among patients with solid and liquid cancer: Analysis of National Inpatient Sample database.

e23073 Background: Pericardial complications (PC) are common in malignancy as sequelae of metastasis, direct toxicity of radiation or chemotherapy, or pericardial infection/inflammation due to malignancy. The goal of this study was to assess the cardiovascular outcomes of pericardial complications among patients with solid and liquid cancer. Methods: The National Inpatient Sample from the years 2015 to 2018 was queried to assess cardiovascular outcomes in the setting of pericardial complications (acute pericarditis, chronic constrictive pericarditis, chronic adhesive pericarditis, hemopericardium, cardiac tamponade and other unspecified pericarditis) for patients that have any solid or liquid malignancy. Outcomes included in-hospital mortality, acute kidney injury (AKI), heart failure (HF), cardiogenic shock (CS), myocardial infarction (MI), sudden cardiac arrest (SCA), mechanical circulatory support (MCS), major adverse cardiovascular and cerebrovascular events (MACCE), and stroke. Outcomes were assessed using chi-square analysis using STATA. Results: A total of 1,183,619 cancer patients with PC (n = 20,410.00; 1.7%) and without PC (n = 1,163,209.60; 98.3%) were included. The mean age of patients with and without PC was 58 and 59 years, respectively. The average length of stay in the hospital was 14 and eight days in patients with and without PC, respectively. The most common complications were electrolyte disorders (51.2%, p = 0.000) and arrhythmias (40.4 %, p = 0.000) for patients with and without PC. Patients with PC had higher incidence of in-hospital mortality (11.7% vs 5.1%, p = 0.000), AKI (37.8% vs 22.1%, p = 0.000), HF (25.7% vs 15.5%, p = 0.000), CS (2.7% vs 0.4%, p = 0.000), MI (3.6% vs 2.0%, p = 0.000), SCA (3.2% vs 1.0%, p = 0.000), MCS (0.7% vs 0.1%, p = 0.000), and MACCE (17% vs 7.9%, p = 0.000) compared to cancer patients without PC. There was no difference in outcomes in terms of stroke (1.2% vs 1.2%, p = 0.879). The yearly trend was stable for length of stay among both groups while adjusted total hospital cost was progressively increasing from 2015 to 2018, with a greater net increase in those with PC. Yearly trends of complications were stable among both cohorts. Conclusions: Pericardial complications are prevalent in up to 1.7% of cancer patients, and they are associated with worse cardiovascular outcomes as compared to patients without pericardial complications. Patients with PC also have a higher incidence of in-hospital mortality.

Differences in mortality between patients with cardiogenic shock due to STEMI treated with PCI vs thrombolysis

Abstract Funding Acknowledgements None. Introduction STEMI is complicated with cardiogenic shock (CS) in approximately 5-10% of cases and mortality is about 40% at 30-day and 50% at 1 year worldwide. In Mexico the incidence of CS in STEMI that received revascularization therapy (PCI or thrombolysis) is between 4.4-4.8%. In our country, pharmacoinvasive strategy (PIs) is the preferred modality due to the lack of PCI centers and demographics. Purpose To demonstrate differences in total ischemia time and 30-day in-hospital mortality in patients treated with PIs or PCI. Methods This was a retrospective observational study of patients that arrived to the emergency room and coronary care unit of the National Institute of Cardiology from January 2018 to March 2023 with CS due to STEMI at presentation, who received reperfusion therapy (PCI or PIs) during the first 12 hours of symptom onset. Results We included 61 patients with CS due to STEMI at presentation, 60.7% received PIs and 39.3% underwent PCI. The prevalence of type 2 diabetes was 38%, hypertension was 28% and obesity was 10% with no significant differences between groups, however the presence of CKD differed significantly with approximately 3% in PCI group versus 0% in PIs group. 21% were smokers and 13% previous smokers. Only 8 patients (13.1%) had a previous MI, 5 patients (8.2%) had previous angioplasty and 4 patients (6.6%) had previous HF. The first medical contact (FMC) occurred at a median of 120 minutes (IQR 75-240 min) overall. For patients undergoing PIs, the FMC was 120 minutes (IQR 70-185 min), whereas for those undergoing PCI, it was 185 minutes (IQR 87-300 min). The total ischemia time was 270 minutes (IQR 180-470 min) overall, with a median of 229 minutes (IQR 163-405 min) for PIs and 396 minutes (IQR 267-592 min) for PCI. The 30-day in-hospital mortality rate was 27.9% overall, significantly lower at 18.9% in the PIs group compared to 41.7% in the PCI group (p=0.01). The average length of hospital stay was 8 days for the PIs population, slightly longer than the 6.5 days observed in the PCI group (p=0.09). Conclusion In this real-world retrospective analysis conducted in our center in a middle-income country showed that PIs impacted positively in 30-day in-hospital mortality of patients who arrived with CS due to STEMI at presentation compared to those that underwent PCI. This effect seems to be secondary to shorter ischemic times since symptom onset due to the use of a prompt reperfusion therapy.

Advanced Metrics and Early Predictors of Cardiogenic Shock

Cardiogenic shock (CS) can be defined as a range of illnesses that describes a state where cardiac output, which is the blood volume ejected from the left ventricle every minute that leads to tissue perfusion of nutrients, is insuffcient in providing adequate oxygenation to the systemic circulation. The incidence of CS on admission has increased in recent years, with the six- and 12-month mortality rates remaining unchanged. The purpose of this literature review is to bring forth several parameters that have been utilized in the past 10 years to predict CS mortality. Further studies to implement these parameters in management algorithms, along with early screenings and advanced treatment options such as mechanical cardiac assist devices, can improve the mortality associated with CS. This literature-based review was conducted by evaluating current research focusing on the clinical presentation of CS and predictors of CS. PubMed served as the primary database for article retrieval due to access. Two searches were conducted: One for clinical presentations and advanced metrics for CS and another for early predictors for CS. Thirteen articles regarding clinical presentation and seven articles regarding early predictors were selected. Three tools/scores and five laboratory tests were identified that allowed clinicians to prognosticate outcomes in patients suffering from CS based on clinical and laboratory presentations. Examining these predictors will allow earlier intervention in the development of CS and potentially help lower the mortality rate of CS. The eventual creation of a scoring system that incorporates multiple metrics discussed in this review can provide the most accurate prognosis of CS, which can lead to more targeted interventions. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Comparison of Conventional Methods with Pump-Controlled Retrograde Trial off for Weaning Adults with Cardiogenic Shock from Veno-Arterial Extracorporeal Membrane Oxygenation.

Pump-controlled retrograde trial off (PCRTO) is a safe, simple, and reversible method for weaning patients from veno-arterial extracorporeal membrane oxygenation (VA-ECMO). However, few studies have compared PCRTO to conventional weaning methods. This retrospective study aimed to compare PCRTO to non-PCRTO methods. This study included patients who were weaned from VA-ECMO from January 2016 to December 2022 at our medical center. Demographic data, ECMO management, ECMO complications, survival to discharge, and cardiogenic shock after VA-ECMO weaning were compared between the 2 groups. Seventy patients who were weaned from VA-ECMO using PCRTO and 85 patients who were weaned with conventional methods were compared. Patient characteristics were not significantly different between the 2 groups. The rate of survival to discharge was significantly higher in the PCRTO group than in the non-PCRTO group (90% vs. 72%, p=0.01). The rates of freedom from all-cause mortality at 10, 30, and 50 days after weaning from ECMO were 75%, 55%, and 35% in the non-PCRTO group and 62%, 60%, and 58% in the PCRTO group, respectively (p=0.1). The incidence of cardiogenic shock after weaning from VA-ECMO was significantly higher in the non-PCRTO group (16% vs. 5%, p=0.04). In logistic regression analysis, PCRTO was a significant factor for survival to discharge (odds ratio, 2.42; 95% confidence interval, 1.29-5.28; p=0.02). Compared to conventional methods, PCRTO is a feasible and reversible method, and it serves as a useful predictor of successful VA-ECMO weaning through a preload stress test.

Pretreatment with parenteral anticoagulation in patients with ST-segment elevation myocardial infarction: a systematic review and meta-analysis

Abstract Background and Aim According to ESC guidelines, parenteral anticoagulation is recommended for all patients presenting with ST-segment elevation myocardial infarction (STEMI) during primary percutaneous coronary intervention (PPCI). However, no specific recommendations are made regarding the timing of administration. In fact, whether upstream anticoagulation improves clinical outcomes in STEMI patients is not well established. We conducted a systematic review and meta-analysis of current evidence on parenteral anticoagulation timing for patients presenting with STEMI. Methods We performed a systematic search of electronic databases (PubMed, CENTRAL and Scopus) until December 2022. Studies were considered eligible if they a) compared upstream anticoagulation with administration at the catheterization lab; and b) enrolled patients with STEMI undergoing PPCI. Studies comparing different anticoagulants were excluded from the analysis. Random-effects meta-analyses were performed. Efficacy outcomes included TIMI flow-grade pre- and post-PPCI, in-hospital cardiogenic shock (CS) and 30-day all-cause mortality. Safety outcome was defined as major in-hospital bleeding events. Results Overall, 9 studies were included (all non-randomized), with a total of 69,571 patients (30,693 in the pretreatment arm). In all but one, anticoagulation strategy was exclusively based on unfractionated heparin. Pretreatment was associated with a significant reduction in the incidence of 30-day all-cause mortality (OR 0.61; 95% CI 0.47-0.80; p<0.001) and in-hospital CS (OR 0.69; 95% CI 0.59-0.81; p<0.001). Upstream anticoagulation was also associated with a significant increase of spontaneous reperfusion of the culprit artery before PPCI (pre-PPCI TIMI > 0: OR 1.47; 95% CI 1.35-1.60; p<0.001) and TIMI flow ≥ 2 after coronary intervention (OR 1.28; 95% CI 1.05-1.56; p=0.016). Regarding safety outcomes, pretreatment was not associated with an increase of in-hospital major bleeding (OR 1.01; 95% CI 0.70-1.44; p=0.970). Multiple sensitivity analyses, including propensity-matched populations, showed consistent results. Conclusions Upstream anticoagulation was associated with a significant lower risk of 30-day all-cause mortality, incidence of in-hospital cardiogenic shock and improved reperfusion of culprit artery. These benefits were not accompanied by an increased risk of major bleeding, suggesting an overall clinical benefit of early anticoagulation in patients presenting with STEMI. These results require confirmation in a randomized clinical trial.

Abstract 17446: Trends, Disparities, and Outcomes in Patients With Takotsubo Cardiomyopathy Complicated by Cardiogenic Shock

Introduction: Cardiogenic shock (CS), a highly fatal complication, is estimated to be seen in up to 20% of patients with Takotsubo cardiomyopathy (TC). Previous studies have found patients with TC to have similar mortality rates as those with acute myocardial infarction, highlighting the potential importance of therapeutic intervention. However, the existing literature on TC is limited. Hypothesis: Minority patients with TC-CS are associated with increased mortality. Methods: All adult admissions with a diagnosis of Takotsubo Cardiomyopathy and cardiogenic shock (TC-CS) were analyzed using the National Inpatient Sample Database between January 2016 and December 2019. Outcomes included in-hospital mortality, in-hospital complications, and resource use. We used multivariate logistics and Elixhauser co-morbidities to adjust for clinical comorbidities. Results: Our study population included 37,902 patients with a diagnosis of Takotsubo cardiomyopathy. Of the sampled population, 2,455 (6.48%) experienced cardiogenic shock. Over the study time period, there was a significant increase in prevalence with TC-CS (p<0.001). Compared to patients with TC, patients with TC-CS were significantly associated with acute kidney injury (OR: 2.463, p<0.001). Controlling for baseline characteristics and Elixhauser comorbidities, Asians were at significantly higher odds of developing cardiogenic shock (OR: 1.859, p<0.001) and mortality, while Whites were at significantly decreased odds of developing cardiogenic shock (OR: 0.690, p<0.001). In addition, Asians who self-pay were at significantly higher odds (OR: 4.836, p=0.005) of developing cardiogenic shock compared with Asians holding insurance. Conclusions: Our study offers insights into the disparities connected with TC-CS. There is a statistically significant increase in the trend of incidence of CS among patients with TC, and CS is associated with significantly higher odds of mortality. Notably, Asian individuals with TC face significantly higher odds of developing CS. However, there were no significant differences in hospitalization costs between races in patients with TC-CS.

Advanced Metrics and Early Predictors of Cardiogenic Shock.

Cardiogenic shock (CS) can be defined as a range of illnesses that describes a state where cardiac output, which is the blood volume ejected from the left ventricle every minute that leads to tissue perfusion of nutrients, is insufficient in providing adequate oxygenation to the systemic circulation. The incidence of CS on admission has increased in recent years, with the six- and 12-month mortality rates remaining unchanged. The purpose of this literature review is to bring forth several parameters that have been utilized in the past 10 years to predict CS mortality. Further studies to implement these parameters in management algorithms, along with early screenings and advanced treatment options such as mechanical cardiac assist devices, can improve the mortality associated with CS. This literature-based review was conducted by evaluating current research focusing on the clinical presentation of CS and predictors of CS. PubMed served as the primary database for article retrieval due to access. Two searches were conducted: One for clinical presentations and advanced metrics for CS and another for early predictors for CS. Thirteen articles regarding clinical presentation and seven articles regarding early predictors were selected. Three tools/scores and five laboratory tests were identified that allowed clinicians to prognosticate outcomes in patients suffering from CS based on clinical and laboratory presentations. Examining these predictors will allow earlier intervention in the development of CS and potentially help lower the mortality rate of CS. The eventual creation of a scoring system that incorporates multiple metrics discussed in this review can provide the most accurate prognosis of CS, which can lead to more targeted interventions.

Trends in the Incidence of Cardiogenic Shock, and Utilization of Mechanical Circulatory Support in Myocarditis: Insights from the National Inpatient Sample 2016 to 2019

A subset of patients with myocarditis present with cardiogenic shock. There is a lack of contemporary data assessing the use of mechanical circulatory support (MCS) in these patients. Myocarditis hospitalizations were analyzed using the National Inpatient Sample between 2016 and 2019. Characteristics of patients with and without cardiogenic shock were assessed. Trends in mortality, MCS, right-sided cardiac catheterization (RHC) and endomyocardial biopsy were evaluated. The impact of RHC on consequent MCS and mortality was studied. A total of 38,300 hospitalizations for myocarditis were included in the study, of which 3,490 hospitalizations (9.1%) had cardiogenic shock. Patients with cardiogenic shock were older (p <0.001) and had more chronic kidney disease and atrial fibrillation. Between 2016 and 2019, there was an increase in myocarditis admissions but no difference in rates of cardiogenic shock and mortality and the use of extracorporeal membrane oxygenation, percutaneous ventricular assist devices, intra-aortic balloon pumps, left ventricular assist devices, and cardiac transplant. The most common form of MCS used in myocarditis was extracorporeal membrane oxygenation. The rates of RHC (p=0.02) and endomyocardial biopsy (p=0.03) increased over time. Patients who underwent RHC were more likely to receive mechanical support, and in patients with shock, RHC was associated with lower mortality (adjusted odds ratio 0.34, p <0.01). Myocarditis admissions increased over time but with no increase in the rates of cardiogenic shock and MCS. In patients with cardiogenic shock, RHC resulted in lower mortality.

Trends and Outcomes of Cardiogenic Shock in Patients With End-Stage Renal Disease: Insights From USRDS Database.

There is a paucity of data regarding epidemiology, temporal trends, and outcomes of patients with cardiogenic shock (CS) and end-stage renal disease (chronic kidney disease stage V on hemodialysis). This is a retrospective cohort study using the United States Renal Data System database from January 1, 2006 to December 31, 2019. We analyzed trends of CS, percutaneous mechanical support (intraaortic balloon pump, percutaneous ventricular assist device [Impella and Tandemheart], and extracorporeal membrane oxygenation) utilization, index mortality, 30-day mortality, and 1-year all-cause mortality in end-stage renal disease patients. A total of 43 825 end-stage renal disease patients were hospitalized with CS (median age, 67.8 years [IQR, 59.4-75.8] and 59.1% men). From 2006 to 2019, the incidence of CS increased from 275 to 578 per 100 000 patients (Ptrend<0.001). The index mortality rate declined from 54.1% in 2006 to 40.8% in 2019 (Ptrend=0.44), and the 1-year all-cause mortality decreased from 63% in 2006 to 61.8% in 2018 (Ptrend=0.73), but neither trend was statistically significant. There was a significantly decreased utilization of intra-aortic balloon pumps from 17 832 to 7992 (Ptrend<0.001), increased utilization of percutaneous ventricular assist device from 137 to 5201 (Ptrend<0.001) and increase in extracorporeal membrane oxygenation use from 69 to 904 per 100 000 patients (Ptrend<0.001). After adjusting for covariates, there was no significant difference in index mortality between CS patients requiring percutaneous mechanical support versus those not requiring percutaneous mechanical support (odds ratio, 0.97 [CI, 0.91-1.02]; P=0.22). On multivariable regression analysis, older age, peripheral vascular disease, diabetes, and time on dialysis were independent predictors of higher index mortality. The incidence of CS in end-stage renal disease patients has doubled without significant change in the trend of index mortality despite the use of percutaneous mechanical support.

Upstream anticoagulation in patients with ST-segment elevation myocardial infarction: a systematic review and meta-analysis.

Parenteral anticoagulation is recommended for all patients presenting with ST-segment elevation myocardial infarction (STEMI) during primary percutaneous coronary intervention (PPCI). Whether upstream anticoagulation improves clinical outcomes is not well established. We conducted a systematic review and meta-analysis of contemporary evidence on parenteral anticoagulation timing for STEMI patients. We performed a systematic search of electronic databases (PubMed, CENTRAL, and Scopus) until December 2022. Studies were eligible if they (a) compared upstream anticoagulation with administration at the catheterization laboratory and (b) enrolled patients with STEMI undergoing PPCI. Efficacy outcomes included in-hospital or 30-day mortality, in-hospital cardiogenic shock (CS), and TIMI flow grade pre- and post-PPCI. Safety outcome was defined as in-hospital or 30-day major bleeding. Overall, seven studies were included (all observational), with a total of69,403 patients. Upstream anticoagulation was associated with a significant reduction in the incidence of in-hospital or 30-day all-cause mortality (OR0.61; 95% CI 0.45-0.81; p < 0.001) and in-hospital CS (OR0.68; 95% CI 0.58-0.81; p < 0.001) and with an increase in spontaneous reperfusion (pre-PPCI TIMI > 0: OR1.46; 95% CI 1.35-1.57; p < 0.001). Pretreatment was not associated with an increase in major bleeding (OR1.02; 95% CI 0.70-1.48; p = 0.930). Upstream anticoagulation was associated with a significantly lower risk of 30-day all-cause mortality, incidence of in-hospital CS, and improved reperfusion of the infarct-related artery (IRA). These findings were not accompanied by an increased risk of major bleeding, suggesting an overall clinical benefit of early anticoagulation in STEMI. These results require confirmation in a dedicated randomized clinical trial.

Haemoglobin drop in patients with myocardial infarction and without previous anaemia is associated with an increased incidence of heart failure and cardiogenic shock

Abstract Funding Acknowledgements Type of funding sources: None. Background It is established that the presence of anaemia is associated with a higher number of complications in patients with myocardial infarction (MI). However, even in patients without history of anaemia, haemoglobin (Hb) drop is often observed. The impact of this decrease in the incidence of heart failure (HF), cardiogenic shock (CS) and reinfarction is still unclear. Purpose This retrospective observational study aims to document if a drop of Hb greater than 2g/dL in patients with MI and without previous anaemia relates to higher rates of HF, CS and reinfarction. Methods We selected a population of 4287 patients admitted with MI with initial Hb between 12 and 15g/dL and without major bleeding at admission (D). We then divided them in two groups: those with a drop of Hb ≥ 2g/dL (D1) and those with an inferior drop (D2) Patient's age, gender, personal history, clinical and electrocardiographic presentation of MI, in-hospital therapy, coronary angiography and left ventricular function were recorded. The incidence of reinfarction, HF and CS was documented. In-hospital mortality was also compared. Multivariate analysis was performed to evaluate whether a drop in Hb was an independent predictor of any of these events. Results D1 consisted of 17,9% of the population (N=863). D1 presented with lower Hb values when compared to D2 (11 ± 1.1 vs 12.9 ± 1.0 g / dL, p &amp;lt; 0.001). These patients were older (70 ± 12 vs 65 ± 13 years, p&amp;lt;0.001), more frequently of the female sex (41,6 vs 27,2%, p&amp;lt;0.001), had a higher prevalence of hypertension (73,3% vs 65,7% p&amp;lt;0.001), diabetes mellitus (36,9 vs 26,9%, p&amp;lt;0,001), history of HF (5,9 vs 4,0%, p=0,013) and chronic renal failure (5,8% vs 3,8%, p=0,003). At the time of admission, D1 underwent more therapy with unfractionated heparin (34,6% vs 26,2%, p&amp;lt;0.001), enoxaparin (66,7% vs 51,7%, p&amp;lt;0.001) and less therapy with fondaparinux (12,7% vs 18,3%, p&amp;lt;0.001). The coronary angiography rate was similar between the groups, but D1 had more frequently the need for repeat angiography (10,7% vs 6,6%, p&amp;lt;0,001), more coronary angiographies by femoral access (40,2% vs 20,2%, p&amp;lt;0.001) and more angioplasties (71,9% vs 68,4%, p=0,04). D1 presented more frequently with HF (24,8% vs 11,1%, p&amp;lt;0,001), cardiogenic shock (10,5% vs 1,7%, p&amp;lt;0,001), reinfarction (2,1% vs 1,1%, p=0,011) and had significantly higher in-hospital mortality (5,0% vs 2,0%, p&amp;lt;0,001). A drop of Hb≥2g/dL was an independent predictor of reinfarction, HF and CS, but not IHM. Conclusions In patients with MI and without previous anaemia nor major bleeding at admission, haemoglobin drop is a predictor of heart failure, cardiogenic shock and reinfarction, but not of in-hospital mortality.

Peripheral artery disease in patients with acute coronary syndrome without ST-segment elevation: impact on therapy and prognosis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Peripheral artery disease (PAD) is an important co-morbidity in non-ST-segment elevation acute coronary syndromes (NSTEMI), and its presence may affect the therapeutic approach and prognosis of these patients. Purpose To assess the impact of PAD presence on therapeutic approach, clinical outcome, and in-hospital and 1-year mortality in patients with NSTEMI. Methods We studied 7248 patients with NSTEMI included in a national multicenter registry. We considered 2 groups: patients with PAD and patients without PAD. Demographic variables, CV risk factors, inpatient therapy, left ventricular function (LVF), coronary angiography and revascularization strategy performed were recorded. The following in-hospital adverse events (AE) were defined: death, re-infarction, stroke, heart failure (HF), cardiogenic shock (CC), major bleeding (MH), need for blood transfusion (BT). Length of stay (IT) and in-hospital and 1-year mortality were evaluated. Multivariate analysis was performed to assess whether the presence of PAD is a predictor of HAS and/or 1-year mortality. Results The presence of PAD was 7.3% (526 patients). These patients were older (70±11 vs 67±13 years, p&amp;lt;0.001), higher prevalence of males (82.1 vs 70.7%, p&amp;lt;0.001), arterial hypertension (87.4 vs 74.1%, p&amp;lt;0.001), diabetes mellitus ( 55.3 vs 32.3%, p&amp;lt;0.001), dyslipidemia (76 vs 61.9%, p&amp;lt;0.001), previous AMI (48.4 vs 24.6%, p&amp;lt;0.001), previous PCI (28.4 vs 17.5%, p&amp;lt;0.001), CABG ( 20.0 vs 6.5%, p&amp;lt;0.001), stroke (25.4 vs 7.5%, p&amp;lt;0.001) and chronic renal failure (22.9 vs 6.3%, p&amp;lt;0.001). Patients with PAD: evolved more frequently in Killip≥II (26.0 vs 13.9%, p&amp;lt;0.001), with LV dysfunction (LVF&amp;lt;50%: 42.7 vs 28.3%, p&amp;lt;0.001) and the need for non-invasive ventilation (3 vs 1.7%, p=0.019). Patients with PAD were less frequently medicated with beta-blockers (75 vs 87.5%, p&amp;lt;0.001) and more frequently with diuretics (47.3 vs 26.6%, p&amp;lt;0.001). Patients with PAD underwent fewer coronary angiograms (69.8 vs 85.6%, p&amp;lt;0.002), but the femoral approach was more used (35.2 vs 21.4%) and had more multivessel disease (76.7 vs 52.4%, p&amp;lt;0.001). Patients with PAD had a longer in-hospital stay duration (median 7 vs 5 days, p&amp;lt;0.001), higher incidence of re-AMI (3.1 vs 1.4%, p=0.003), HF (26.7 vs 12.4%, p=0.002), CC (3.2 vs 1.8%, p=0.016), MH (2.3 vs 1.1%, p=0.001) and BT (4.6 vs 1.6%, p&amp;lt;0.001), but not stroke. In-hospital mortality was higher (4 vs 2%, p=0.003) as well as 1-year mortality (16.2 vs 6.2%, p&amp;lt;0.001). By multivariate analysis, PAD was an independent predictor of 1-year mortality (OR=1.57, 95% CI [1.04-2.58], p=0.032), but not of AE. Conclusion The presence of PAD affects the therapy and revascularization strategy in patients with NSTEMI, being associated with higher in-hospital morbidity and mortality. This co-morbidity constitutes an independent predictor of death at 1 year.

Contemporary Management of Cardiogenic Shock Complicating Acute Myocardial Infarction.

Despite an improvement in pharmacological therapies and mechanical reperfusion, the outcome of patients with acute myocardial infarction (AMI) is still suboptimal, especially in patients with cardiogenic shock (CS). The incidence of CS accounts for 3-15% of AMI cases, with mortality rates of 40% to 50%. In contrast to a large number of trials conducted in patients with AMI without CS, there is limited evidence-based scientific knowledge in the CS setting. Therefore, recommendations and actual treatments are often based on registry data. Similarly, knowledge of the available options in terms of temporary mechanical circulatory support (MCS) devices is not equally widespread, leading to an underutilisation or even overutilisation in different regions/countries of these treatment options and nonuniformity in the management of CS. The aim of this article is to provide a critical overview of the available literature on the management of CS as a complication of AMI, summarising the most recent evidence on revascularisation strategies, pharmacological treatments and MCS use.

Abstract P579: Predictors of Cardiogenic Shock Among Patients With Alcohol Abuse Undergoing SAVR in the United States

Introduction: While alcohol is a modifiable cause of cardiac complications, its use is on the rise. We sought to understand the predictors of cardiogenic shock (CS) among patients with a history of alcohol abuse undergoing surgical aortic valve replacement (SAVR). Hypothesis: We assessed the hypothesis that patients with alcohol abuse undergoing SAVR have various predictors of CS during hospitalization. Method: We retrospectively analyzed cases of SAVR among those with a diagnosis of alcohol abuse from the 2019 National Inpatient Sample. Logistic models helped find the adjusted odds ratio (aOR) of CS. Results: In total, 1980 patients with alcohol abuse underwent SAVR, and 10.9% (215 cases) reported an episode of CS. Blacks (aOR 2.553, CI 1.354-4.814, p=0.004) and races other than White, Black, or Hispanic (aOR 3.136, CI 1.29-7.62, p=0.012) showed higher odds of CS compared to Whites. While Medicare covered the highest proportion of CS patients (39.5%), Medicaid beneficiaries were least likely to develop CS (aOR 0.241, CI 0.132 -0.442, p&lt;0.01) compared to those on Medicare. Our study also found that patients with anemia (aOR 10.317, CI 5.234-20.334, p&lt;0.01), acute kidney injury (aOR 3.921, CI 2.54-6.052, p&lt;0.01), and cirrhosis (aOR 4.587, CI 2.719-7.736, p&lt;0.01), had higher odds of reporting CS. However, those with underlying obesity (aOR 0.237, CI 0.126-0.447, p&lt;0.01), diabetes mellitus (aOR 0.344, CI 0.197-0.602, p&lt;0.01), and hypertension (aOR 0.436, CI 0.264-0.721, p&lt;0.01) were less likely to do so. Unfortunately, 25 patients with CS (11.6%) did not survive their hospitalization (aOR 13.771, 95% CI 5.526-34.317, p&lt;0.01). Conclusion: In our analysis, we found that anemia, acute kidney injury, cirrhosis, Black race, and Races other than Black, White or Hispanic are possibly linked to a higher incidence of CS, while obesity, diabetes mellitus, hypertension, and being a Medicaid beneficiary are associated with a lower incidence of CS. Further studies and changes in protocols may help identify them early and improve outcomes.

Association of socioeconomic status in the incidence, quality-of-care metrics, and outcomes for patients with cardiogenic shock in a pre-hospital setting.

The relationship between lower socioeconomic status (SES) and poor cardiovascular outcomes is well described; however, there exists a paucity of data exploring this association in cardiogenic shock (CS). This study aimed to investigate whether any disparities exist between SES and the incidence, quality of care or outcomes of CS patients attended by emergency medical services (EMS). This population-based cohort study included consecutive patients transported by EMS with CS between 1 January 2015 and 30 June 2019 in Victoria, Australia. Data were collected from individually linked ambulance, hospital, and mortality datasets. Patients were stratified into SES quintiles using national census data produced by the Australian Bureau of Statistics.A total of 2628 patients were attended by EMS for CS. The age-standardized incidence of CS amongst all patients was 11.8 [95% confidence interval (95% CI), 11.4-12.3] per 100000 person-years, with a stepwise increase from the highest to lowest SES quintile (lowest quintile 17.0vs. highest quintile 9.7 per 100000 person-years, P-trend<0.001). Patients in lower SES quintiles were less likely to attend metropolitan hospitals and more likely to be received by inner regional and remote centres without revascularization capabilities. A greater proportion of the lower SES groups presented with CS due to non-ST elevation myocardial infarction (NSTEMI) or unstable angina pectoris (UAP), and overall were less likely to undergo coronary angiography. Multivariable analysis demonstrated an increased 30-day all-cause mortality rate in the lowest three SES quintiles when compared with the highest quintile. This population-based study demonstrated discrepancies between SES status in the incidence, care metrics, and mortality rates of patients presenting to EMS with CS. These findings outline the challenges in equitable healthcare delivery within this cohort.

Takotsubo cardiomyopathy after cardiac surgery: A case-series and systematic review of literature.

Takotsubo cardiomyopathy (TTC) is a rare entity after cardiac surgery. To describe patients' profile who developed postoperative TTC after cardiac surgery, management, and outcomes. We performed a systematic literature search to extract cases of TTC after adult cardiac surgery (from 1990 to 2021). Additionally, we extracted all cases of TTC in a prospective single-center cohort database of 10,000+ patients (from 2007 to 2019). We then combined all cases in a single cohort to describe its clinical features. From 694 screened articles, we retained 71 individual cases published in 20 distinct articles (19 cases reports and 1 case-series). We combined these to 10 cases extracted from our cohort [among 10,682 patients (0.09%)]. Overall, we included 81 cases. Patients were aged 68 ± 10 years-old and 64/81 (79%) were women. Surgery procedures included mitral valve and/or tricuspid valve surgery in 70/81, 86%. TTC was diagnosed in the first days after surgery [median 4 (1-4) days]. Incidence of cardiogenic shock, defined as requirement of vasopressor and/or inotropic support was 24/29, 83% (data available on 29/81 patients). Refractory cardiogenic appeared in 5/81, 6% who required implantation of arterio-venous extra-corporeal membrane oxygenation, and 6/81, 7%, intra-aortic balloon pump. In-hospital mortality was 5/81, 6%. This systematic review, based on case reports and case series, showed that postoperative TTC appears as a rare complication after cardiac surgery and mainly occurred after mitral and/or tricuspid valve repair procedures. In this population, TTC is associated with high rate of cardiogenic shock.

Involvement of Vasopressin in Tissue Hypoperfusion during Cardiogenic Shock Complicating Acute Myocardial Infarction in Rats

Acute heart failure (AHF) due to acute myocardial infarction (AMI) is likely to involve cardiogenic shock (CS), with neuro-hormonal activation. A relationship between AHF, CS and vasopressin response is suspected. This study aimed to investigate the implication of vasopressin on hemodynamic parameters and tissue perfusion at the early phase of CS complicating AMI. Experiments were performed on male Wistar rats submitted or not to left coronary artery ligation (AMI and Sham). Six groups were studied Sham and AMI treated or not with either a vasopressin antagonist SR-49059 (Sham-SR, AMI-SR) or agonist terlipressin (Sham-TLP, AMI-TLP). Animals were sacrificed one day after surgery (D1) and after hemodynamic parameters determination. Vascular responses to vasopressin were evaluated, ex vivo, on aorta. AHF was defined by a left ventricular ejection fraction below 40%. CS was defined by AHF plus tissue hypoperfusion evidenced by elevated serum lactate level or low mesenteric oxygen saturation (SmO2) at D1. Mortality rates were 40% in AMI, 0% in AMI-SR and 33% in AMI-TLP. Immediately after surgery, a sharp decrease in SmO2 was observed in all groups. At D1, SmO2 recovered in Sham and in SR-treated animals while it remained low in AMI and further decreased in TLP-treated groups. The incidence of CS among AHF animals was 72% in AMI or AMI-TLP while it was reduced to 25% in AMI-SR. Plasma copeptin level was increased by AMI. Maximal contractile response to vasopressin was decreased in AMI (32%) as in TLP- and SR- treated groups regardless of ligation. Increased vasopressin secretion occurring in the early phase of AMI may be responsible of mesenteric hypoperfusion resulting in tissue hypoxia. Treatment with a vasopressin antagonist enhanced mesenteric perfusion and improve survival. This could be an interesting therapeutic strategy to prevent progression to cardiogenic shock.

PS-C16-1: COURSE OF ACS IN PATIENTS CO-INFECTED WITH COVID-19

Aim: To study and compare the features of the course of ACS in patients who underwent COVID19 infection. Material and Methods: The study included ACS patients with ST segment elevation admitted from January 2021 to February 2022. Patients were compared with a group of patients who did not suffer from COVID 19 infection and were hospitalized for ACS in a similar period of time. The study included 114 patients. In all patients, the presence of IgG antibodies to the agent of the coronavirus infection COVID-19 was determined, which indicates that the person has already had a coronavirus infection or not. Patients were divided into 2 groups: 1 - patients who had COVID19 infection; 2 - not recovered from coronavirus infection. All patients were assessed the following indicators: the presence of coronary artery disease before hospitalization, the incidence of cardiogenic shock, the presence of STEMI, as well as the number of deaths during hospitalization. Results: In the first group, only 39.5% (45) of patients were examined, of which men - 80.0% (36). Prior to hospitalization, coronary artery disease was present in 64.4% (29) of patients. STEMI was present in 75.5% (34) of patients. The incidence of cardiogenic shock in 4.4% (2) of patients. The number of deaths during hospitalization is 4.4% (2). In the second group, only 60.5% (69) of patients were examined, of which 78.3% (54) were men. Prior to hospitalization, CAD was present in 55.07% (38) of patients. STEMI was recorded in 59.4% (41) of patients. The incidence of cardiogenic shock is 1.45% of patients. The number of deaths during hospitalization was 1.45%. Conclusion: Before hospitalization, CAD was present in the majority of patients 39.5% (45) who had COVID 19, who did not have COVID19 patients 60.5% (69). STEMI was present in 75.5% (34) of patients who had COVID19 and 59.4% (41) of those who did not have COVID 19 infection (p &lt; 0.05). During the pandemic, there is a high incidence of cardiogenic shock in 4.4% (2) of patients who have had COVID19 and 1.45% (1) of those who have not been ill. The percentage of deaths during hospitalization in COVID19 survivors is higher compared to 4.4% with 1.45% who did not recover.

Age as a predictor of clinical outcomes and determinant of therapeutic measures for emergency medical services treated cardiogenic shock.

The impact of age on outcomes in cardiogenic shock (CS) is poorly described in the pre-hospital setting. We assessed the impact of age on outcomes of patients treated by emergency medical services (EMS). This population-based cohort study included consecutive adult patients with CS transported to hospital by EMS. Successfully linked patients were stratified into tertiles by age (18-63, 64-77, and > 77 years). Predictors of 30-day mortality were assessed through regression analyses. The primary outcome was 30-day all-cause mortality. A total of 3523 patients with CS were successfully linked to state health records. The average age was 68 ± 16 years and 1398 (40%) were female. Older patients were more likely to have comorbidities including pre-existing coronary artery disease, hypertension, dyslipidemia, diabetes mellitus, and cerebrovascular disease. The incidence of CS was significantly greater with increasing age (incidence rate per 100,000 person years 6.47 [95% CI: 6.1-6.8] in age 18-63 years, 34.34 [32.4-36.4] in age 64-77 years, 74.87 [70.6-79.3] in age > 77 years, P < 0.001). There was a step-wise increase in the rate of 30-day mortality with increasing age tertile. After adjustment, compared to the lowest age tertile, patients aged > 77 years had increased risk of 30-day mortality (adjusted hazard ratio = 2.26 [95% CI: 1.96-2.60]). Older patients were less likely to receive inpatient coronary angiography. Older patients with EMS-treated CS have significantly higher rates of short-term mortality. The reduced rates of invasive interventions in older patients underscore the need for further development of systems of care to improve outcomes for this patient group.

Abstract 11100: Persistent Gender Disparities in STEMI Mortality: Insights From the Midwest STEMI Consortium

Introduction: Over the past two decades, national and regional initiatives have been dedicated to closing the gender gap and resolving disparities in STEMI care and outcomes for females. In this study, we explored how gender disparities have evolved in a well-established regional STEMI system in the US. Methods: Using the Midwest STEMI Consortium database, we examined sex differences in STEMI treatment and outcomes when stratified by decade from 2003 to 2009 versus 2010 to 2020. Results: Among 12,878 consecutive STEMI patients, 30.3% were female. Females were older and more likely to have a history of hypertension and diabetes as compared to males in both time periods (2003-2009 and 2010-2020). Females persistently had longer door-to-balloon times, underwent less revascularization with PCI, and received GDMT less often than males in both time periods. From 2003 to 2009, the incidence of cardiogenic shock was higher in females. Despite improvements in the rate of in-hospital mortality in the last decade, the post-discharge to 1-year mortality risk was significantly higher in females compared to males in both time periods. Conclusions: Over the past two decades, gender disparities in STEMI care and outcomes have persisted. Despite an improvement in the rate of in-hospital mortality, sex differences persist with females having a higher risk of discharge to 1-year mortality. This is in part due to persistent discrepancies in baseline comorbidities and patient care, including longer door-to-balloon times and less GDMT at discharge. These findings underscore the need for both regional and national efforts to close this persistent gap.