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. 2020 Mar 28;9(4):931.
doi: 10.3390/jcm9040931.

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

Benedikt Schrage  1   2 , Jessica Weimann  1 , Salim Dabboura  2 , Isabell Yan  1 , Rafel Hilal  1 , Peter Moritz Becher  1 , Moritz Seiffert  1 , Alexander M Bernhardt  3 , Stefan Kluge  4 , Hermann Reichenspurner  3 , Stefan Blankenberg  1   2 , Dirk Westermann  1   2
Affiliations

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

Benedikt Schrage et al. J Clin Med. .

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.

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Conflict of interest statement

BS has received speakers fee from AstraZeneca. MS received honoraria from Abbott, Biotronik, Boston Scientific, Edwards Lifesciences, and Medtronic. AB is consultant for Abbott, Abiomed, BerlinHeart and Medtronic. SK has received lecture honoraria and travel costs from Baxter, Fresenius, Sorin and Xenios. HR received honoraria from Abiomed. SB received honoraria from Abbott, Siemens, Thermo Fisher and Roche.DW received honorary from AstraZeneca, Bayer, Berlin-Chemie and Novartis. The other authors report no conflict of interest

Figures

Figure 1
Figure 1
Patient characteristics of patients with non-ischemic vs. ischemic cardiogenic shock. Multivariable-adjusted logistic regression model with cause of cardiogenic shock (CS, non-ischemic vs. ischemic) as the dependent variable and all shown baseline characteristics as independent variables. Odds ratios (OR) are shown on the x-axis. Change in continuous variables was modeled as change per standard deviation. CI: confidence interval; ROSC: return of spontaneous circulation.
Figure 2
Figure 2
Use of treatments in patients with non-ischemic vs. ischemic cardiogenic shock. Logistic regression model with cause of cardiogenic shock (CS, non-ischemic vs. ischemic) as the dependent variable and all shown baseline treatments as independent variables. Additionally, all models were adjusted for age, sex, prior cardiac arrest, time to return of spontaneous circulation, shock index ≥1, baseline lactate and baseline pH. Odds ratios (OR) are shown on the x-axis. Change in continuous variables was modeled as change per standard deviation. CI: confidence interval; ECMO: veno-arterial extracorporeal membrane oxygenation; pLVAD: perivascular left-ventricular assist device.
Figure 3
Figure 3
30 day in-hospital mortality in patients with non-ischemic vs. ischemic cardiogenic shock. Multivariable Cox regression model is adjusted for age, sex, prior cardiac arrest, time to return of spontaneous circulation, shock index ≥1, baseline lactate and baseline pH. HR: hazard ratio; CS: cardiogenic shock.
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