Use of mechanical circulatory support in patients with non‐ischaemic cardiogenic shock

Abstract

Aims Despite its high incidence and mortality risk, there is no evidence‐based treatment for non‐ischaemic cardiogenic shock (CS). The aim of this study was to evaluate the use of mechanical circulatory support (MCS) for non‐ischaemic CS treatment. Methods and results In this multicentre, international, retrospective study, data from 890 patients with non‐ischaemic CS, defined as CS due to severe de‐novo or acute‐on‐chronic heart failure with no need for urgent revascularization, treated with or without active MCS, were collected. The association between active MCS use and the primary endpoint of 30‐day mortality was assessed in a 1:1 propensity‐matched cohort. MCS was used in 386 (43%) patients. Patients treated with MCS presented with more severe CS (37% vs. 23% deteriorating CS, 30% vs. 25% in extremis CS) and had a lower left ventricular ejection fraction at baseline (21% vs. 25%). After matching, 267 patients treated with MCS were compared with 267 patients treated without MCS. In the matched cohort, MCS use was associated with a lower 30‐day mortality (hazard ratio 0.76, 95% confidence interval 0.59–0.97). This finding was consistent through all tested subgroups except when CS severity was considered, indicating risk reduction especially in patients with deteriorating CS. However, complications occurred more frequently in patients with MCS; e.g. severe bleeding (16.5% vs. 6.4%) and access‐site related ischaemia (6.7% vs. 0%). Conclusion In patients with non‐ischaemic CS, MCS use was associated with lower 30‐day mortality as compared to medical therapy only, but also with more complications. Randomized trials are needed to validate these findings.

April 2023 at a glance: focus on diagnosis and comorbidities

“…The mortality of cardiogenic shock remains exceedingly high 36 . Shrage et al 37 . compared with propensity matching 267 patients treated with mechanical circulatory support (MCS) with 267 patients treated without in a multicentre, international, cohort of patients with non‐ischaemic cardiogenic shock.…”

“…The mortality of cardiogenic shock remains exceedingly high. 36 Shrage et al 37 compared with propensity matching 267 patients treated with mechanical circulatory support (MCS) with 267 patients treated without in a multicentre, international, cohort of patients with non-ischaemic cardiogenic shock. MCS was associated with a lower 30-day mortality (hazard ratio 0.76, 95% CI 0.59-0.97), even if complications occurred more frequently (e.g.…”

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“…In this issue of the Journal, Schrage et al 8 . used a large, retrospective, international, multicentre database to evaluate mechanical circulatory support (MCS) use in NI‐CS.…”

“…6 Moreover, the EURO-SHOCK trial designed to include ischaemic and NI-CS patients randomized between ECMO and medical management was recently prematurely stopped for slow inclusion rate (only 22 inclusions on 428 planned). 7 In this issue of the Journal, Schrage et al 8 used a large, retrospective, international, multicentre database to evaluate mechanical circulatory support (MCS) use in NI-CS. This is the first large-scale analysis of the relationship between MCS use and mortality in these severe patients.…”

Differences between cardiogenic shock related to acute decompensated heart failure and acute myocardial infarction

“…[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], P = 0.001] although ADHF-CS had longer duration of administration of catecholamines [epinephrine: 144 (IQR 48-336) vs. 48 (IQR 24-114) hours, P = 0.04; dobutamine: 70 (IQR 31-201) vs. 47 (IQR 16-97) hours, P = 0.01; dopamine: 81 (IQR 35-636) vs. 12 (IQR 4-73) hours, P = 0.02]. The use of sodium nitroprusside was remarkably different between the two groups (20.7% in AMI-CS and 59.3% in -ADHF-CS, P < 0.001).…”