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. 2023 Dec;10(6):3472-3482.
doi: 10.1002/ehf2.14510. Epub 2023 Sep 18.

Differences between cardiogenic shock related to acute decompensated heart failure and acute myocardial infarction

Maurizio Bertaina  1 , Nuccia Morici  2 , Simone Frea  3 , Laura Garatti  4 , Martina Briani  5 , Carlotta Sorini  6 , Luca Villanova  4 , Elena Corrada  5 , Alice Sacco  4 , Marco Moltrasio  7 , Amelia Ravera  8 , Michele Tedeschi  8 , Letizia Bertoldi  5 , Maddalena Lettino  9 , Francesco Saia  10 , Anna Corsini  10 , Rita Camporotondo  11 , Costanza Natalia Julia Colombo  11 , Stephanie Bertolin  12 , Matteo Rota  13 , Fabrizio Oliva  4 , Mario Iannaccone  1 , Serafina Valente  6 , Matteo Pagnesi  14 , Marco Metra  14 , Alessandro Sionis  15 , Marco Marini  16 , Gaetano Maria De Ferrari  3   17 , Navin K Kapur  18 , Federico Pappalardo  12 , Guido Tavazzi  19   20
Affiliations

Differences between cardiogenic shock related to acute decompensated heart failure and acute myocardial infarction

Maurizio Bertaina et al. ESC Heart Fail. 2023 Dec.

Abstract

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.

Keywords: Cardiogenic shock; Heart failure; Mortality; Myocardial infarction.

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Conflict of interest statement

Nuccia Morici and Alice Sacco receives institutional grant support from Getinge Global US; Alice Sacco receives speaker honoraria from AstraZeneca and Menarini; Navin K. Kapur receives consulting/speaker honoraria and institutional grant support from Abbott Laboratories, Abiomed, Inc, Boston Scientific, Edwards, LivaNova, Getinge, Teleflex. and Zoll. Federico Pappalardo is a consultant for Abiomed. Fabrizio Oliva receives speaker honoraria from AstraZeneca, Viphor, Orion, and Novartis and has been involved in the advisory board of Novartis, AstraZeneca, and Bayer. Marco Marini receives consulting/speaker honoraria from AstraZeneca, Orion, and Abiomed. The other authors have nothing to declare.

Figures

Figure 1
Figure 1
Aetiologies of cardiogenic shock (CS) patients enrolled in the Altshock‐2 Registry from March 2020 to February 2021 (above) and cohort of patients with acute myocardial infarction (AMI)‐CS or acute decompensated heart failure (ADHF)‐CS selected for the present analysis (below).
Figure 2
Figure 2
Society for Cardiovascular Angiography and Interventions (SCAI) class at admission in the whole cohort and according to cardiogenic shock (CS) aetiology. ADHF, acute decompensated heart failure; AMI, acute myocardial infarction.
See this image and copyright information in PMC

References

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