Outcomes Of Cardiogenic Shock Research Articles

How preclinical models help to improve outcome in cardiogenic shock.

Preclinical experimentation of cardiogenic shock resuscitation on large animal models represents a powerful tool to decipher its complexity and improve its poor outcome, when small animal models are lacking external validation, and clinical investigation are limited due to technical and ethical constraints. This review illustrates the currently available preclinical models addressing reliably the physiopathology and hemodynamic phenotype of cardiogenic shock, highlighting on the opposite questionable translation based on low severity acute myocardial infarction (AMI) models. Three types of preclinical models replicate reliably AMI-related cardiogenic shock, either with coronary microembolization, coronary deoxygenated blood perfusion or double critical coronary sub-occlusion. These models overcame the pitfall of frequent periprocedural cardiac arrest and offer, to different extents, robust opportunities to investigate pharmacological and/or mechanical circulatory support therapeutic strategies, cardioprotective approaches improving heart recovery and mitigation of the systemic inflammatory reaction. They all came with their respective strengths and weaknesses, allowing the researcher to select the right preclinical model for the right clinical question. AMI-related cardiogenic shock preclinical models are now well established and should replace low severity AMI models. Technical and ethical constraints are not trivial, but this translational research is a key asset to build up meaningful future clinical investigations.

Trends in primary percutaneous coronary intervention for the treatment of acute coronary ST-elevation myocardial infarction in Latin American countries: insights from the CECI consortium.

ST-elevation myocardial infarction (STEMI) requires revascularization treatment, preferably via primary percutaneous coronary interventions (pPCI). There is a lack of data about contemporary management of STEMI in Latin America. This was a multicenter, multinational, prospective, and dynamic registry of patients undergoing pPCI in Latin America for STEMI (STEMI/LATAMI Registry) that was carried out in nine centers from five countries (Argentina, Ecuador, Venezuela, Bolivia, and the Dominican Republic) between June 2021 and June 2023. All interventionalists involved in the study were originally trained at the same institution (Centro de Estudios en Cardiología Intervencionista, Buenos Aires, Argentina). The primary objective was to evaluate procedural and in-hospital outcomes of pPCI in STEMI and in-hospital outcome in the Latin America (LATAM) region; as secondary endpoints, we analyzed the following subgroups: differences between pPCI vs. pharmaco-invasive or late presenters, gender, elderly and very elderly patients, cardiogenic shock outcomes, and causes of STEMI. In total, 744 STEMI patients who underwent PCI between June 2021 and June 2023 in five countries (nine centers) in our continent were included; 76.3% had a pPCI, 8.1% pharmaco-invasive PCI, and 15.6% had late STEMI PCI. There were no differences in region or center when we evaluated in-hospital and 30 days of death. The rate of procedural success was 96.2%, and the overall in-hospital mortality rate was 2.2%. In the subgroup of pPCI, mean symptom onset-to-balloon time was 295.3 ± 246 min, and mean door-to-balloon time was 55.8 ± 49.9 min. The femoral approach was chosen in 60.5%. In 3.0% of patients, the left main disease was the culprit artery, with 1.63 ± 1.00 stents per patient (564 drug-eluting stents and 652 bare metal stents), with 34 patients receiving only plain optimal balloon angioplasty. Definitive stent thrombosis was related to the infarct artery as the primary cause of STEMI in 7.5% of patients. The use of assistant mechanical devices was low, at 2.1% in the pPCI group. Women were older, with large numbers in very elderly age (≥90 years), greater mortality, and incidence of spontaneous coronary dissection as a cause of STEMI (p < 0.001, p < 0.001, p < 0.001, and p < 0.003, respectively). In suitable LATAM Centers from low/medium-income countries, this prospective registry in patients with STEMI, PCI performed by well-trained operators has comparable results to those reported in well-developed countries.

Clinical Characteristics, Management and Outcomes in Cardiogenic Shock: insights from a high-volume Italian Cardiac Intensive Care Unit

Cardiogenic shock (CS) is a life-threatening condition. We aim to evaluate clinical characteristics, management and complication rate of patients with CS admitted in a high-volume hospital in Italy. We retrospectively reviewed the clinical, echocardiographic and laboratory data, therapeutic management and outcomes of patients with CS admitted to the Policlinico Gemelli (Rome) between January 1, 2020, and January 1, 2023. ​ We included 96 patients (median age 71 years, IQR 60-79; 65 [68%] males), of whom 49 patients (51%) presented CS secondary to acute myocardial infarction and 60 (63%) with a de-novo presentation of CS. Dobutamine was the most frequently used inotrope and noradrenaline the most frequently used vasopressor (adopted in 56% and 82% of cases respectively). Forty-five (47%) patients died during the hospitalization. Non-survivors were older, presented a higher inflammatory burden at admission, elevated lactate levels, a greater increase in lactate levels, higher left ventricular filling pressures and worse right ventricular function. C-Reactive Protein (CRP) levels [odd ratio (OR) 1.03, 95% confidence interval (CI) [1.00;1.04], p=0.027), lactate levels at admission (OR 3.49, 95% CI [1.59;7.63], p=0.02) and increase in lactate levels (OR 2.8, 95% CI [1.37;5.75], p=0.005) were independent predictors of in-hospital all cause death. Our data contribute to assess the regional variations in management and outcomes of patients with CS. We observed a high mortality and complication rate. Lactate acidosis and CRP measured at admission, may help in identifying patients at higher risk of adverse in-hospital outcomes.

(476) - Impact of Cumulative Vasopressor and Inotrope Medications on Outcomes in Cardiogenic Shock: A Cardiogenic Shock Working Group Report

(476) - Impact of Cumulative Vasopressor and Inotrope Medications on Outcomes in Cardiogenic Shock: A Cardiogenic Shock Working Group Report

Serial daily lactate levels association with 30-day outcome in cardiogenic shock patients treated with VA-ECMO: a post-hoc analysis of the HYPO-ECMO study

BackgroundReliable predictors of outcomes in venoarterial extracorporeal membrane oxygenation (VA-ECMO) therapy are limited. While elevated lactate levels over time have been linked to outcomes in cardiogenic shock (CS), their significance in VA-ECMO-treated patients remains inconclusive.MethodsWe conducted a post hoc analysis of data from the HYPO-ECMO trial, which compared normothermia to moderate hypothermia in CS patients supported by VA-ECMO. We examined daily lactate levels collected over a week to assess their correlation with 30-day mortality.ResultsAmong the 318 out of 334 patients (95%) with baseline lactate measurements, 66 had normal levels (< 2.2 mmol/l, 21%). No difference was found in lactate course between moderate hypothermia and normothermia groups. Lactate levels were consistently higher in non-survivors at each time point (p = 0.0002). Baseline hyperlactatemia was associated with an increased risk of death (Hazard Ratio [HR]: 1.85 (1.12–3.05), p = 0.016). When considering all time points, lactate levels during the ICU stay were significantly and gradually associated with a higher risk of death (p < 0.0001). In the overall population, a decrease in lactate levels was not linked to 30-day mortality. However, patients with baseline hyperlactatemia exhibited a more significant decrease in lactate levels from day one to seven (p < 0.0001). In this group, survivors had a significantly greater decrease in lactate levels at day 1 compared to non-survivors (63% (48–77) versus 57% (21–75), p = 0.026). Patients experiencing a secondary increase in lactate (24%) had a worse prognosis (Hazard Ratio: 1.78 (1.21–2.61), p = 0.004), regardless of both baseline lactate levels and the occurrence of severe ischemic adverse events (intestinal and/or limb ischemia).ConclusionsThe consistent and significant association between lactate levels, whether assessed at baseline or during ICU treatment, and the risk of mortality underscores the pivotal prognostic relevance of lactate levels in patients with CS undergoing VA-ECMO therapy. The study findings provide some novel insights, regarding the trend profile and the relevance of a second peak during the 7 day period after ECMO start.Trial Registration identifier NCT02754193 registered on 2016–04–12.

Clinical Outcomes of Cardiogenic Shock due to Spontaneous Coronary Artery Dissection versus Cardiogenic Shock due to Coronary Artery Disease.

Spontaneous coronary artery dissection (SCAD) can be treated conservatively. However, some SCAD patients can develop cardiogenic shock (CS). We evaluated the outcomes of SCAD-related CS using data from a national population-based cohort study from January 1, 2016, to December 30, 2019. In our study of 32,640 patients with SCAD, about 10.6% of patients presented with cardiogenic shock. We found that SCAD patients with cardiogenic shock had higher mortality as well as greater complications including use of mechanical circulatory devices, arrythmias, respiratory support, and acute heart failure compared to those without cardiogenic shock. When comparing cardiogenic shock due to SCAD with that due to coronary artery disease (CAD), we found that while mortality rates were similar, those with cardiogenic shock due to SCAD were associated with higher risk of use of mechanical circulatory support, major bleeding, blood transfusion and respiratory failure.

Cardiogenic shock and chronic kidney disease: Dangerous liaisons

BackgroundChronic kidney disease (CKD) is one of the leading causes of death worldwide, closely interrelated with cardiovascular diseases, ultimately leading to the failure of both organs – the so-called “cardiorenal syndrome”. Despite this burden, data related to cardiogenic shock outcomes in CKD patients are scarce. MethodsFRENSHOCK (NCT02703038) was a prospective registry involving 772 patients with cardiogenic shock from 49 centres. One-year outcomes (rehospitalization, death, heart transplantation, ventricular assist device) were analysed according to history of CKD at admission and were adjusted on independent predictive factors. ResultsCKD was present in 164 of 771 patients (21.3%) with cardiogenic shock; these patients were older (72.7 vs. 63.9years) and had more comorbidities than those without CKD. CKD was associated with a higher rate of all-cause mortality at 1month (36.6% vs. 23.2%; hazard ratio 1.39, 95% confidence interval 1.01–1.9; P=0.04) and 1year (62.8% vs. 40.5%, hazard ratio 1.39, 95% confidence interval 1.09–1.77; P<0.01). Patients with CKD were less likely to be treated with norepinephrine/epinephrine or undergo invasive ventilation or receive mechanical circulatory support, but were more likely to receive renal replacement therapy (RRT). RRT was associated with a higher risk of all-cause death at 1month and 1year regardless of baseline CKD status. ConclusionsCardiogenic shock and CKD are frequent “cross-talking” conditions with limited therapeutic options, resulting in higher rates of death at 1month and 1year. RRT is a strong predictor of death, regardless of preexisting CKD. Multidisciplinary teams involving cardiac and kidney physicians are required to provide integrated care for patients with failure of both organs.

Impact of anaemia and iron deficiency on outcomes in cardiogenic shock complicating acute myocardial infarction.

Anaemia and iron deficiency (ID) are common comorbidities in cardiovascular patients and are associated with a poor clinical status, as well as a worse outcome in patients with heart failure and acute myocardial infarction (AMI). Nevertheless, data concerning the impact of anaemia and ID on clinical outcomes in patients with cardiogenic shock (CS) are scarce. This study aimed to assess the impact of anaemia and ID on clinical outcomes in patients with CS complicating AMI. The presence of anaemia (haemoglobin <13 g/dl in men and <12 g/dl in women) or ID (ferritin <100 ng/ml or transferrin saturation <20%) was determined in patients with CS due to AMI from the CULPRIT-SHOCK trial. Blood samples were collected in the catheterization laboratory during initial percutaneous coronary intervention. Clinical outcomes were compared in four groups of patients having neither anaemia nor ID, against patients with anaemia with or without ID and patients with ID only. A total of 427 CS patients were included in this analysis. Anaemia without ID was diagnosed in 93 (21.7%), anaemia with ID in 54 study participants (12.6%), ID without anaemia in 72 patients (16.8%), whereas in 208 patients neither anaemia nor ID was present (48.9%). CS patients with anaemia without ID were older (73 ± 10 years, p = 0.001), had more frequently a history of arterial hypertension (72.8%, p = 0.01), diabetes mellitus (47.8%, p = 0.001), as well as chronic kidney disease (14.1%, p = 0.004) compared to CS patients in other groups. Anaemic CS patients without ID presence were at higher risk to develop a composite from all-cause death or renal replacement therapy at 30-day follow-up (odds ratio [OR] 3.83, 95% confidence interval [CI] 2.23-6.62, p < 0.001) than CS patients without anaemia/ID. The presence of ID in CS patients, with and without concomitant anaemia, did not increase the risk for the primary outcome (OR 1.17, 95% CI 0.64-2.13, p = 0.64; and OR 1.01, 95% CI 0.59-1.73, p = 0.54; respectively) within 30 days of follow-up. In time-to-event Kaplan-Meier analysis, anaemic CS patients without ID had a significantly higher hazard ratio (HR) for the primary outcome (HR 2.11, 95% CI 1.52-2.89, p < 0.001), as well as for death from any cause (HR 1.90, 95% CI 1.36-2.65, p < 0.001) and renal replacement therapy during 30-day follow-up (HR 2.99, 95% CI 1.69-5.31, p < 0.001). Concomitant anaemia without ID presence in patients with CS at hospital presentation is associated with higher risk for death from any cause or renal replacement therapy and the individual components of this composite endpoint within 30 days after hospitalization. ID has no relevant impact on clinical outcomes in patients with CS.

EPidemiology Of Cardiogenic sHock in Scotland (EPOCHS): A multicentre, prospective observational study of the prevalence, management and outcomes of cardiogenic shock in Scotland.

Despite high rates of cardiovascular disease in Scotland, the prevalence and outcomes of patients with cardiogenic shock are unknown. We undertook a prospective observational cohort study of consecutive patients with cardiogenic shock admitted to the intensive care unit (ICU) or coronary care unit at 13 hospitals in Scotland for a 6-month period. Denominator data from the Scottish Intensive Care Society Audit Group were used to estimate ICU prevalence; data for coronary care units were unavailable. We undertook multivariable logistic regression to identify factors associated with in-hospital mortality. In total, 247 patients with cardiogenic shock were included. After exclusion of coronary care unit admissions, this comprised 3.0% of all ICU admissions during the study period (95% confidence interval [CI] 2.6%-3.5%). Aetiology was acute myocardial infarction (AMI) in 48%. The commonest vasoactive treatment was noradrenaline (56%) followed by adrenaline (46%) and dobutamine (40%). Mechanical circulatory support was used in 30%. Overall in-hospital mortality was 55%. After multivariable logistic regression, age (odds ratio [OR] 1.04, 95% CI 1.02-1.06), admission lactate (OR 1.10, 95% CI 1.05-1.19), Society for Cardiovascular Angiographic Intervention stage D or E at presentation (OR 2.16, 95% CI 1.10-4.29) and use of adrenaline (OR 2.73, 95% CI 1.40-5.40) were associated with mortality. In Scotland the prevalence of cardiogenic shock was 3% of all ICU admissions; more than half died prior to discharge. There was significant variation in treatment approaches, particularly with respect to vasoactive support strategy.

Obesity and outcomes in cardiogenic shock due to acute myocardial infarction

Abstract Background Obesity paradox in heart failure (HF) is defined as better outcomes associated with higher body mass index (BMI). Purpose We explored the relationship between BMI and outcomes in cardiogenic shock (CS) due to acute myocardial infarction. Methods The Cardiogenic Shock Working Group (CSWG) registry includes patients with CS, regardless of etiology, from 17 clinical sites across the USA. In- hospital mortality, as a main outcome measure, was analyzed depending on BMI as a continuous variable, as well as BMI quartiles (BMI≤24.4 kg/m2, 24.433.1 kg/m2) for the subset of CS due to acute myocardial infarction (AMI-CS). We also explored mortality in categorized BMI subsets (underweight, normal weight, overweight, obese, and morbidly obese). Results A total of 969 patients with AMI-CS were included. The in-hospital mortality was 42.4%. When analyzed as a continuous variable, BMI had no association with survival to discharge. When the cohort was divided into quartiles according to BMI, mortality was consistent with 42.2%, 38.5%, 39.5%, and 49.3%, respectively, p=0.082. In categorized subsets, mortality was 30% in the underweight, 42.9% in the normal weight, 37.4% in the overweight, 44.5.% in the obese, and 47.9% in morbidly obese, p=0.15. Conclusions In acute myocardial infarction-related cardiogenic shock, obesity creates no survival advantage.

One-year outcomes in cardiogenic shock triggered by supraventricular tachycardia: an analysis of the FRENSHOCK multicenter prospective registry

Abstract Background Cardiogenic shock (CS) is the most severe form of heart failure (HF), resulting in high early and long-term mortality. Characteristics of CS secondary to supraventricular tachycardia (SVT) are poorly reported. Based on a large registry of unselected CS, our aim was to compare one-year outcomes between SVT-triggered and non-SVT-triggered CS. Methods FRENSHOCK is a prospective registry including 772 CS from 49 centers. One to three triggers could be identified (ischemic, mechanical complications, ventricular/supraventricular arrhythmia, bradycardia, iatrogenesis, infection, non-compliance, others). One-year outcomes (rehospitalizations, mortality, heart transplantation (HTx), ventricular assist devices (VAD)) were analyzed, adjusted on independent predictive factors. Results Within 769 CS included, 100 were SVT-triggered (13%) with 65 with SVT as exclusive trigger (8.5%). SVT triggered CS patients were more male with more frequent history of cardiomyopathy or chronic kidney disease, and more profound CS (biventricular failure and multiorgan failure). At 1-year, there was no difference in all-cause mortality (HR 0.91 [0.66 – 1.26], p = 0.58), need for HTx or VAD (OR 0.88 [0.41 – 1.88], p = 0.74) or rehospitalizations (OR 1.24 [0.78 – 1.98], p = 0.36). Patients with SVT as exclusive trigger presented more 1-year rehospitalizations (OR 3.74 [1.05 – 10.5], p = 0.01). Conclusion SVT is a frequent trigger of CS alone or in association in more than 10% of miscellaneous CS. Although SVT-triggered CS patients were more comorbid with more pre-existing cardiomyopathies and HF, they presented similar rates of mortality, HTx and VAD at 1-year arguing for a better overall prognosis.Graphical abstract

Abstract 12328: Impact of Female Sex on Cardiogenic Shock Outcomes - A Cardiogenic Shock Working Group Report

Introduction: Studies reporting cardiogenic shock (CS) outcomes in women are scarce. Hypothesis: Among patients with CS complicating acute myocardial infarction (AMI-CS) and heart failure (HF-CS), women have worse survival at discharge and more vascular complications than men. Methods: We analyzed 5,083 CS patients in the Cardiogenic Shock Working Group. Propensity score matching (PSM) was performed using baseline characteristics. Logistic regression was performed for log odds of survival. Results: Among 5,083 patients, 1,522 were women (30%) with a mean age of 66.5±13.2 years. There were 30% women and 29.1% men with AMI-CS (p=0.03). More women presented with de novo HF-CS compared to men (26.2% vs. 19.3%, p&lt;0.001). Before PSM, differences in baseline characteristics and sex-specific outcomes were seen in the HF-CS cohort, with worse survival at discharge (69.9% vs. 74.4%, p=0.009) (Figure A) and higher maximum SCAI stage E (26% vs. 21%, p=0.04) in women than men (Figure B). Women were less likely to receive pulmonary artery catheters (52.9% vs. 54.6%, p&lt;0.001), heart transplant (6.5% vs. 10.3%, p&lt;0.001) or left ventricular assist device (7.8% vs. 10%, p=0.01). Differences in AMI-CS cohort were less discrepant. Regardless of CS etiology, women had more vascular complications (8.8% vs. 5.7%, p&lt;0.001), bleeding (7.1% vs. 5.2%, p=0.01), and limb ischemia (6.8% vs. 4.5%, p=0.001) (Figure C). More vascular complications persisted in women after PSM (10.4% women vs. 7.4% men, p=0.06). Conclusions: Women with HF-CS had worse outcomes and more vascular complications than men with HF-CS. More studies are needed to identify barriers to advanced therapies, decrease complications and improve outcomes of women with CS.

Abstract 17955: Cost-Effectiveness of a Shock Team Approach in Refractory Cardiogenic Shock

Background: Multidisciplinary Shock Teams have improved clinical outcomes for cardiogenic shock (CS), but their implementation costs have not been studied. Objectives: To compare costs between patients treated with and without a Shock Team and determine if the team's implementation is cost-effective compared to standard of care (SoC). Methods: We examined patients with refractory CS, treated with or without a Shock Team at a tertiary academic hospital from 2009-2018. Real-world hospital data was used to compare costs and outcomes, including survival at discharge, 1-year survival, and quality adjusted life years (QALYs) gained at 1 year. Incremental cost-effectiveness ratios (ICER) were calculated over a 1-year time horizon, with parameter uncertainty evaluated through probabilistic sensitivity analysis using (PSA) 1000 second-order Monte Carlo simulations. Results: The study involved 244 patients, with 123 treated by the Shock Team and 121 receiving SoC. Patients were predominantly male (77.5%), with a mean age of 58 years (18-92). The Shock Team approach improved survival rates at hospital discharge and 1-year follow-up (61.0% vs 47.9%; p=0.04 &amp; 55.0% vs 40.5%; p=0.03, respectively). The ICER for increases in survival probability at discharge for the multidisciplinary Shock Team compared to SoC was $102,088. The ICER for increases in survival probability at 1-year was estimated at $96,152 and at $127,862 per one QALY gained. PSA estimates showed that the Shock Team was cost-effective in the majority of simulations using a willingness-to-pay threshold of $150,000, while it was also dominant in almost one-third of the simulations. Conclusion: The Shock Team approach for treating refractory CS may be a cost-effective alternative to traditional SoC. These findings can help prioritize the implementation of Shock Team initiatives to further improve cardiogenic shock outcomes.

Impact of Female Sex on Cardiogenic Shock Outcomes: A Cardiogenic Shock Working Group Report

BackgroundStudies reporting cardiogenic shock (CS) outcomes in women are scarce. ObjectivesThe authors compared survival at discharge among women vs men with CS complicating acute myocardial infarction (AMI-CS) and heart failure (HF-CS). MethodsThe authors analyzed 5,083 CS patients in the Cardiogenic Shock Working Group. Propensity score matching (PSM) was performed with the use of baseline characteristics. Logistic regression was performed for log odds of survival. ResultsAmong 5,083 patients, 1,522 were women (30%), whose mean age was 61.8 ± 15.8 years. There were 30% women and 29.1% men with AMI-CS (P = 0.03). More women presented with de novo HF-CS compared with men (26.2% vs 19.3%; P < 0.001). Before PSM, differences in baseline characteristics and sex-specific outcomes were seen in the HF-CS cohort, with worse survival at discharge (69.9% vs 74.4%; P = 0.009) and a higher rate of maximum Society for Cardiac Angiography and Interventions stage E (26% vs 21%; P = 0.04) in women than in men. Women were less likely to receive pulmonary artery catheterization (52.9% vs 54.6%; P < 0.001), heart transplantation (6.5% vs 10.3%; P < 0.001), or left ventricular assist device implantation (7.8% vs 10%; P = 0.01). Regardless of CS etiology, women had more vascular complications (8.8% vs 5.7%; P < 0.001), bleeding (7.1% vs 5.2%; P = 0.01), and limb ischemia (6.8% vs 4.5%; P = 0.001). More vascular complications persisted in women after PSM (10.4% women vs 7.4% men; P = 0.06). ConclusionsWomen with HF-CS had worse outcomes and more vascular complications than men with HF-CS. More studies are needed to identify barriers to advanced therapies, decrease complications, and improve outcomes of women with CS.

Impact of day of admission on in-hospital outcomes of cardiogenic shock

BackgroundThe management of cardiogenic shock (CS) requires attentiveness to details and in some cases, invasive interventions. In the past, studies have shown relationships between the day of admission and cardiovascular outcomes. We aim to analyze the trends and in-hospital outcomes of patients admitted with CS over the weekends compared to weekdays. MethodWe identified all patients with CS from the National Inpatient Sample (NIS) database between 2016 and 2020. Using multivariate logistic regression analysis, baseline demographics and in-hospital outcomes were obtained and compared by weekend or weekday admission. ResultsOut of 854,684 CS admissions, 199,255 (23.6%) occurred on weekends. Patients admitted over the weekend had worse outcomes, including higher rates of mortality (aOR 1.09 CI 1.05 – 1.11, p<0.001), cardiac arrest (aOR 1.09 CI 1.04 -1.14, p<0.001), and respiratory failure. We also noted higher percutaneous coronary intervention (PCI) rates (aOR 1.2 CI 1.16 – 1.25, p<0.001) but lower rates of pulmonary artery catheterization (PAC) and post-procedure pneumothorax. Weekend admissions had shorter hospital lengths of stay, and they incurred lower charges ($223,222 vs. $247,908).Between 2016 and 2020, we observed a consistent downward trend in the mortality rates of the weekend and weekday CS admissions, with consistently higher weekend than weekday admissions. ConclusionWeekend admissions for CS are associated with worse outcomes, which have persisted for years. This now begs the question of whether physician dissatisfaction, understaffing, or burn-out are responsible for this finding.

TCT-490 Sex-Specific Temporal Trends in Incidence and Outcomes of Cardiogenic Shock in Acute Myocardial Infarction Patients Treated With Percutaneous Coronary Intervention

TCT-490 Sex-Specific Temporal Trends in Incidence and Outcomes of Cardiogenic Shock in Acute Myocardial Infarction Patients Treated With Percutaneous Coronary Intervention

TCT-704 Impact of Sex on Cardiogenic Shock Outcomes: A Cardiogenic Shock Working Group Report

TCT-704 Impact of Sex on Cardiogenic Shock Outcomes: A Cardiogenic Shock Working Group Report

TCT-736 Impact of Interhospital Transfers on Cardiogenic Shock Outcomes in a Metropolitan Health Network

TCT-736 Impact of Interhospital Transfers on Cardiogenic Shock Outcomes in a Metropolitan Health Network

The Impact of Sex on Cardiogenic Shock Outcomes Following ST Elevation Myocardial Infarction.

Cardiogenic shock (CS) remains the leading cause of ST elevation myocardial infarction (STEMI)-related mortality. Contemporary studies have shown no sex-related differences in mortality. STEMI-CS patients undergoing primary percutaneous coronary intervention (PPCI) were included based on a dedicated prospective STEMI database. We compared sex-specific differences in CS characteristics at baseline, during hospitalization, and in subsequent clinical outcomes. Endpoints included all-cause mortality and major adverse cardiac events (MACE). Of 3202 consecutive STEMI patients, 210 (6.5%) had CS, of which 63 (30.0%) were women. Women were older than men (73.2 vs. 65.5% y, p < 0.01), and more had hypertension (68.3 vs. 52.8%, p = 0.019) and diabetes (38.7 vs. 24.8%, p = 0.047). Fewer were smokers (13.3 vs. 41.2%, p < 0.01), had previous PCI (9.1 vs. 22.3% p = 0.016), or required IABP (35.3 vs. 51.1% p = 0.027). Women had higher rates of mortality (53.2 vs. 35.3% in-hospital, p = 0.01; 61.3 vs. 41.9% at 1 month, p = 0.01; and 73.8 vs. 52.6% at 3 years, p = 0.05) and MACE (60.6 vs. 41.6% in-hospital, p = 0.032; 66.1 vs. 45.6% at 1 month, p = 0.007; and 62.9 vs. 80.3% at 3 years, p = 0.015). After multivariate adjustment, female sex remained an independent factor for death (HR-2.42 [95% CI 1.014-5.033], p = 0.042) and MACE (HR-1.91 [95% CI 1.217-3.031], p = 0.01). CS complicating STEMI is associated with greater short- and long-term mortality and MACE in women. Sex-focused measures to improve diagnosis and treatment are mandatory for CS patients.

One-year outcomes in cardiogenic shock triggered by supraventricular tachycardia: an analysis of the FRENSHOCK multicenter prospective registry.

Cardiogenic shock (CS) is the most severe form of heart failure (HF), resulting in high early and long-term mortality. Characteristics of CS secondary to supraventricular tachycardia (SVT) are poorly reported. Based on a large registry of unselected CS, we aimed to compare 1-year outcomes between SVT-triggered and non-SVT-triggered CS. FRENSHOCK is a French prospective registry including 772 CS patients from 49 centers. For each patient, the investigator could report 1-3 CS triggers from a pre-established list (ischemic, mechanical complications, ventricular/supraventricular arrhythmia, bradycardia, iatrogenesis, infection, non-compliance, and others). In this study, 1-year outcomes [rehospitalizations, mortality, heart transplantation (HTx), ventricular assist devices (VAD)] were analyzed and adjusted for independent predictive factors. Among 769 CS patients included, 100 were SVT-triggered (13%), of which 65 had SVT as an exclusive trigger (8.5%). SVT-triggered CS patients exhibited a higher proportion of male individuals with a more frequent history of cardiomyopathy or chronic kidney disease and more profound CS (biventricular failure and multiorgan failure). At 1 year, there was no difference in all-cause mortality (43% vs. 45.3%, adjusted HR 0.9 (95% CI 0.59-1.39), p = 0.64), need for HTx or VAD [10% vs. 10%, aOR 0.88 (0.41-1.88), p = 0.74], or rehospitalizations [49.4% vs. 44.4%, aOR 1.24 (0.78-1.98), p = 0.36]. Patients with SVT as an exclusive trigger presented more 1-year rehospitalizations [52.8% vs. 43.3%, aOR 3.74 (1.05-10.5), p = 0.01]. SVT is a frequent trigger of CS alone or in association in more than 10% of miscellaneous CS cases. Although SVT-triggered CS patients were more comorbid with more pre-existing cardiomyopathies and HF incidences, they presented similar rates of mortality, HTx, and VAD at 1 year, arguing for a better overall prognosis. https://clinicaltrials.gov, identifier: NCT02703038.