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Observational Study
. 2022 Jun;15(6):e009279.
doi: 10.1161/CIRCHEARTFAILURE.121.009279. Epub 2022 May 5.

Cardiogenic Shock From Heart Failure Versus Acute Myocardial Infarction: Clinical Characteristics, Hospital Course, and 1-Year Outcomes

Shashank S Sinha #  1 , Carolyn M Rosner #  1 , Behnam N Tehrani  1 , Aneel Maini  2 , Alexander G Truesdell  1   3 , Seiyon Ben Lee  4 , Pramita Bagchi  4 , James Cameron  4 , Abdulla A Damluji  1 , Mehul Desai  1 , Shashank S Desai  1 , Kelly C Epps  1 , Christopher deFilippi  1 , M Casey Flanagan  1 , Leonard Genovese  1 , Hala Moukhachen  1 , James J Park  1 , Mitchell A Psotka  1 , Anika Raja  1 , Palak Shah  1 , Matthew W Sherwood  1 , Ramesh Singh  1 , Daniel Tang  1 , Karl D Young  1 , Timothy Welch  1   3 , Christopher M O'Connor  1 , Wayne B Batchelor  1
Affiliations
Observational Study

Cardiogenic Shock From Heart Failure Versus Acute Myocardial Infarction: Clinical Characteristics, Hospital Course, and 1-Year Outcomes

Shashank S Sinha et al. Circ Heart Fail. 2022 Jun.

Abstract

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.

Keywords: heart failure; hemodynamics; mortality; myocardial infarction; shock, cardiogenic.

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Figures

Figure 1.
Figure 1.. CONSORT Diagram.
Flow diagram depicting the enrollment of Cardiogenic Shock patients during the study period, from initial presentation to hospital discharge and at one-year post hospital discharge, comparing patients with Cardiogenic Shock related to Heart Failure (HF-CS) to patients with Cardiogenic Shock related to an Acute Myocardial Infarction (AMI-CS).
Figure 2:
Figure 2:. One-Year Cumulative Mortality for Patients Hospitalized for Cardiogenic Shock.
Figure depicting the Kaplan-Meier Survival curves for Cardiogenic Shock patients in the year following initial presentation, comparing cumulative mortality in patients with Cardiogenic Shock related to Heart Failure (HF-CS) to patients with Cardiogenic Shock related to an Acute Myocardial Infarction (AMI-CS).
Figure 3:
Figure 3:. All-Cause Mortality Conditional on Survival to Hospital Discharge.
Figure depicting the Kaplan-Meier Survival curves for Cardiogenic Shock patients in the year following initial presentation, comparing cumulative mortality in patients with Cardiogenic Shock related to Heart Failure (HF-CS) to patients with Cardiogenic Shock related to an Acute Myocardial Infarction (AMI-CS), conditional on those who survived to hospital discharge.
Figure 4.
Figure 4.. Clinical Predictors of One-Year Mortality in AMI-CS Patients and HF-CS Patients.
Figures depicting the assessment of independent clinical predictors of one-year mortality for: A) patients treated for Cardiogenic Shock related to an Acute Myocardial Infarction (AMI-CS) and B) patients treated for Cardiogenic Shock related to acutely decompensated Heart Failure (HF-CS).
Figure 4.
Figure 4.. Clinical Predictors of One-Year Mortality in AMI-CS Patients and HF-CS Patients.
Figures depicting the assessment of independent clinical predictors of one-year mortality for: A) patients treated for Cardiogenic Shock related to an Acute Myocardial Infarction (AMI-CS) and B) patients treated for Cardiogenic Shock related to acutely decompensated Heart Failure (HF-CS).
Figure 5.
Figure 5.. Comparison of Baseline Characteristics, Hospital Course, and One-Year Mortality for AMI-CS vs. HF-CS Patients.
Figure depicting the differences in presentation, acute hospital management, and one-year mortality in patients treated for Cardiogenic Shock related to an Acute Myocardial Infarction (AMI-CS) compared to patients treated for Cardiogenic Shock related to acutely decompensated Heart Failure (HF-CS).
See this image and copyright information in PMC

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