Patient Characteristics, Treatment and Outcome in Non-Ischemic vs. Ischemic Cardiogenic Shock

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.

Temporal trends in incidence, causes, use of mechanical circulatory support and mortality in cardiogenic shock

“…The rapidly growing group of non‐ischemic cardiogenic shock cases will include patients with severe heart failure due to distant myocardial infarction, due to cardiomyopathies, and due to other causes such as hypertension. A similar pattern was reported in a small study from the USA and in a small study from our own institution, where the majority of the patients presented with non‐ischemic cardiogenic shock and less than a third of the cases could be attributed to acute myocardial infarction 15,16 . Additionally, formation of cardiac arrest centres and shock teams might have contributed to the observed increase in case numbers, as both might have facilitated early diagnosis (e.g.…”

“…A similar pattern was reported in a small study from the USA and in a small study from our own institution, where the majority of the patients presented with non-ischemic cardiogenic shock and less than a third of the cases could be attributed to acute myocardial infarction. 15,16 Additionally, formation of cardiac arrest centres and shock teams might have contributed to the observed increase in case numbers, as both might have facilitated early diagnosis (e.g. identifying cardiogenic shock as the leading cause of admission) and correct triage of cardiogenic shock patients, thereby raising awareness for and correct labelling of these cases.…”

Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation

“…It is increasingly recognized that various diseases can cause cardiogenic shock and that the majority of cases are not caused by acute myocardial infarction. 17 , 18 Because the only evidence-based treatment is early revascularization of the culprit lesion in cardiogenic shock caused by acute myocardial infarction, it is important to identify other treatments that cover the whole spectrum of cardiogenic shock. 19 , 20 …”

Cardiogenic shock: incidence, survival and mechanical circulatory support usage 2007–2017-insights from a national registry

“…Rare findings are mechanical complications of AMI, such as ventricular septum defect (VSD), rupture of the free wall or papillary muscle rupture with subsequent severe acute mitral regurgitation. Recent papers hint at present high numbers of non-ischemic shock scenarios (up to 52%) [4]. They may result from pulmonary embolism, pericardial tamponade, myocarditis, arrhythmia, valvular disease, decompensated congestive heart failure or other cardiomyopathies (peripartal, autoimmune, stress induced) [5,6].…”