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Use of mechanical circulatory support in patients with non-ischaemic cardiogenic shock
B. Schrage, J. Sundermeyer, BN. Beer, L. Bertoldi, A. Bernhardt, S. Blankenberg, J. Dauw, Z. Dindane, D. Eckner, I. Eitel, T. Graf, P. Horn, P. Kirchhof, S. Kluge, A. Linke, U. Landmesser, P. Luedike, E. Lüsebrink, N. Mangner, O. Maniuc, SM....
Language English Country England, Great Britain
Document type Multicenter Study, Journal Article, Research Support, Non-U.S. Gov't
NLK
Medline Complete (EBSCOhost)
from 2000-03-01 to 1 year ago
Wiley Free Content
from 1999 to 1 year ago
PubMed
36781178
DOI
10.1002/ejhf.2796
Knihovny.cz E-resources
- MeSH
- Ventricular Function, Left MeSH
- Intra-Aortic Balloon Pumping methods MeSH
- Shock, Cardiogenic etiology therapy MeSH
- Humans MeSH
- Heart-Assist Devices * adverse effects MeSH
- Retrospective Studies MeSH
- Heart Failure * complications MeSH
- Stroke Volume MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
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.
Anesthesia and Intensive Care Fondazione Policlinico San Matteo Hospital IRCCS Pavia Italy
Cardio Center Humanitas Clinical and Research Center IRCCS Milan Italy
Department of Cardiology and Angiology University Heart Center Freiburg Germany
Department of Cardiology Charité Universitätsmedizin Berlin Berlin Germany
Department of Cardiology IKEM Prague Czech Republic
Department of Cardiology Paracelsus Medical University Nürnberg Nürnberg Germany
Department of Cardiology University Heart and Vascular Center Hamburg Hamburg Germany
Department of Cardiology Ziekenhuis Oost Limburg Genk Belgium
Department of Cardiothoracic Surgery University Heart and Vascular Center Hamburg Hamburg Germany
Department of Clinical Surgical Diagnostic and Paediatric Sciences University of Pavia Pavia Italy
Department of Internal Medicine 1 University Hospital Jena Jena Germany
Department of Internal Medicine 1 University Hospital Würzburg Würzburg Germany
Department of Perioperative Medicine St Bartholomew's Hospital London UK
Doctoral School for Medicine and Life Sciences LCRC Diepenbeek Belgium
German Center for Cardiovascular Research Partner site Hamburg Kiel Lübeck Hamburg Germany
Herzzentrum Dresden Technische Universität Dresden Dresden Germany
IRCCS Santa Maria Nascente Fondazione Don Carlo Gnocchi ONLUS Milan Italy
Medizinische Klinik 2 Kliniken Nordoberpfalz AG Weiden Germany
Medizinische Klinik und Poliklinik 1 Klinikum der Universität München Munich Germany
University Heart Center Lübeck University Hospital Schleswig Holstein Lübeck Germany
University Medical Center Hamburg Eppendorf Department of Intensive Care Medicine Hamburg Germany
References provided by Crossref.org
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