Differences between cardiogenic shock related to acute decompensated heart failure and acute myocardial infarction.
Por:
Bertaina M, Morici N, Frea S, Garatti L, Briani M, Sorini C, Villanova L, Corrada E, Sacco A, Moltrasio M, Ravera A, Tedeschi M, Bertoldi L, Lettino M, Saia F, Corsini A, Camporotondo R, Colombo CNJ, Bertolin S, Rota M, Oliva F, Iannaccone M, Valente S, Pagnesi M, Metra M, Sionis A, Marini M, De Ferrari GM, Kapur NK, Pappalardo F, Tavazzi G
Publicada:
18 sep 2023
Ahead of Print:
18 sep 2023
Resumen:
AIMS: The present analysis from the multicentre prospective Altshock-2 registry aims to better define clinical features, in-hospital course, and management of cardiogenic shock complicating acutely decompensated heart failure (ADHF-CS) as compared with that complicating acute myocardial infarction (AMI-CS). METHODS AND RESULTS: All patients with AMI-CS or ADHF-CS enrolled in the Altshock-2 registry between March 2020 and February 2022 were selected. The primary objective was the characterization of ADHF-CS patients as compared with AMI-CS. In-hospital length of stay and mortality were secondary endpoints. One-hundred-ninety of the 238 CS patients enrolled in the aforementioned period were considered for the present analysis: 101 AMI-CS (80% ST-elevated myocardial infarction and 20% non-ST-elevated myocardial infarction) and 89 ADHF-CS. As compared with AMI-CS, ADHF-CS patients were younger [63 (IQR 59-76) vs. 67 (IQR 54-73) years, P = 0.01], but presented with higher creatinine [1.6 (IQR 1.0-2.6) vs. 1.2 (IQR 1.0-1.4) mg/dL, P < 0.001], bilirubin [1.3 (IQR 0.9-2.3) vs. 0.6 (IQR 0.4-1.1) mg/dL, P = 0.01], and central venous pressure values [14 mmHg (IQR 8-12) vs. 10 mmHg (IQR 7-14),P = 0.01]. Norepinephrine was the most common catecholamine used in AMI-CS (79.3%), whereas epinephrine was used more commonly in ADHF-CS (65.5%); 75.8% vs. 46.6% received a temporary mechanical support in AMI-CS and ADHF-CS, respectively (P < 0.001). Length of hospital stay was longer in the latter [28 (IQR 13-48) vs. 17 (IQR 9-29) days, P = 0.001]. Heart replacement therapies were more frequently used in the ADHF-CS group (heart transplantation 13.5% vs. 0% and left ventricular assist device 11% vs. 2%, P < 0.01 and 0.01, respectively). In-hospital mortality was 41.1% (38.6% AMI-CS vs. 43.8% ADHF-CS, P = 0.5). CONCLUSIONS: ADHF-CS is characterized by a higher prevalence of end-organ and biventricular dysfunction at presentation, a longer hospital length of stay, and higher need of heart replacement therapies when compared with AMI-CS. In-hospital mortality was similar between the two aetiologies. Our data warrant development of new management protocols focused on CS aetiology.
Filiaciones:
Bertaina M:
Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
Morici N:
IRCCS S. Maria Nascente-Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
Frea S:
Intensive Cardiac Care Unit, Città della Salute e della Scienza di Torino, Turin, Italy
Garatti L:
Cardiology Department and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
Briani M:
Humanitas Research Hospital, IRCCS Rozzano, Milan, Italy
Sorini C:
Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
Villanova L:
Cardiology Department and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
Corrada E:
Humanitas Research Hospital, IRCCS Rozzano, Milan, Italy
Sacco A:
Cardiology Department and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
Moltrasio M:
Centro Cardiologico Monzino IRCCS, Milan, Italy
Ravera A:
Cardiology Department, Intensive Care Unit, S. Giovanni Di Dio e Ruggi D'Aragona Hospital, Salerno, Italy
Tedeschi M:
Cardiology Department, Intensive Care Unit, S. Giovanni Di Dio e Ruggi D'Aragona Hospital, Salerno, Italy
Bertoldi L:
Humanitas Research Hospital, IRCCS Rozzano, Milan, Italy
Lettino M:
Cardiovascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
Saia F:
Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
Corsini A:
Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
Camporotondo R:
Intensive Cardiac Care Unit, Fondazione Policlinico San Matteo Hospital IRCCS, Pavia, Italy
Colombo CNJ:
Intensive Cardiac Care Unit, Fondazione Policlinico San Matteo Hospital IRCCS, Pavia, Italy
Bertolin S:
Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
Rota M:
Units of Biostatistics and Biomathematics and Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
Oliva F:
Cardiology Department and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
Iannaccone M:
Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
Valente S:
Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
Pagnesi M:
Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Cardiothoracic Department, Civil Hospitals, Brescia, Italy
Metra M:
Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Cardiothoracic Department, Civil Hospitals, Brescia, Italy
Sionis A:
Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Marini M:
Division of Cardiology and ICCU, Department of Cardiovascular Sciences, Ospedali Riuniti, Ancona, Italy
De Ferrari GM:
Intensive Cardiac Care Unit, Città della Salute e della Scienza di Torino, Turin, Italy
Department of Medical Sciences, University of Torino, Turin, Italy
Kapur NK:
CardioVascular Center, Tufts Medical Center, Boston, MA, USA
Pappalardo F:
Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
Tavazzi G:
Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, University of Pavia Italy, Pavia, Italy
Anesthesia and Intensive Care, Fondazione Policlinico San Matteo Hospital IRCCS, Anestesia e Rianimazione I, Pavia, Italy
gold, All Open Access; Gold
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