29 Jun Cardiogenic Shock From Heart Failure Versus Acute Myocardial Infarction: Clinical Characteristics, Hospital Course, and 1-Year Outcomes
Circulation: Heart Failure, <a href=»https://www.ahajournals.org/toc/circheartfailure/15/6″>Volume 15, Issue 6</a>, Page e009279, June 1, 2022.
Background:Little is known about clinical characteristics, hospital course, and longitudinal outcomes of patients with cardiogenic shock (CS) related to heart failure (HF-CS) compared to acute myocardial infarction (AMI; CS related to AMI [AMI-CS]).Methods:We examined in-hospital and 1-year outcomes of 520 (219 AMI-CS, 301 HF-CS) consecutive patients with CS (January 3, 2017–December 31, 2019) in a single-center registry.Results:Mean age was 61.5±13.5 years, 71% were male, 22% were Black patients, and 63% had chronic kidney disease. The HF-CS cohort was younger (58.5 versus 65.6 years,P<0.001), had fewer cardiac arrests (15.9% versus 35.2%,P<0.001), less vasopressor utilization (61.8% versus 82.2%,P<0.001), higher pulmonary artery pulsatility index (2.14 versus 1.51,P<0.01), lower cardiac power output (0.64 versus 0.77 W,P<0.01) and higher pulmonary capillary wedge pressure (25.4 versus 22.2 mm Hg,P<0.001) than patients with AMI-CS. Patients with HF-CS received less temporary mechanical circulatory support (34.9% versus 76.3%P<0.001) and experienced lower rates of major bleeding (17.3% versus 26.0%,P=0.02) and in-hospital mortality (23.9% versus 39.3%,P<0.001). Postdischarge, 133 AMI-CS and 229 patients with HF-CS experienced similar rates of 30-day readmission (19.5% versus 24.5%,P=0.30) and major adverse cardiac and cerebrovascular events (23.3% versus 28.8%,P=0.45). Patients with HF-CS had lower 1-year mortality (n=123, 42.6%) compared to the patients with AMI-CS (n=110, 52.9%,P=0.03). Cumulative 1-year mortality was also lower in patients with HF-CS (log-rank test,P=0.04).Conclusions:Patients with HF-CS were younger, and despite lower cardiac power output and higher pulmonary capillary wedge pressure, less likely to receive vasopressors or temporary mechanical circulatory support. Although patients with HF-CS had lower in-hospital and 1-year mortality, both cohorts experienced similarly high rates of postdischarge major adverse cardiovascular and cerebrovascular events and 30-day readmission, highlighting that both cohorts warrant careful long-term follow-up.Registration:URL:https://www.clinicaltrials.gov; Unique identifier: NCT03378739.