Differences Between Ischemic and Nonischemic Cardiomyopathy in Heart Failure Related Cardiogenic Shock

Abstract

Background: Heart failure-related cardiogenic shock (HF-CS) accounts for a growing proportion of cardiogenic shock (CS)-related admissions to contemporary cardiac intensive care units. Limited data exist comparing nonischemic (NICM) and ischemic cardiomyopathy (ICM) in this setting.

Methods and results: We sought to examine the differences in patients' characteristics, in-hospital treatments and outcomes in individuals admitted with ICM and NICM HF-CS. The study population included CS admissions within the Critical Care Cardiology Trials Network registry from 2017-2022. CS due to acute myocardial infarction or secondary causes was excluded. Admission characteristics, in-hospital treatments and outcomes were captured. The primary outcome of all-cause in-hospital mortality for ICM vs NICM was compared by using multivariable logistic regression; 2463 hospital admissions for HF-CS, including 902 (36.6%) admissions with ICM and 1561 (63.4%) admissions with NICM, were included. Patients with ICM more commonly had pre-existing comorbidities, pre-admission cardiac arrest and higher Sequential Organ Failure Assessment scores. The use of inotropes and temporary mechanical circulatory support was similar; however, the rates of mechanical ventilation and renal-replacement therapies were higher for ICM. Patients with ICM were less likely to undergo cardiac transplantation but had similar rates of durable left ventricular assist device implantation. After multivariable adjustment, patients with ICM were significantly more likely to die during the index hospitalization (OR 1.56, 95% CI 1.26-1.93; P < 0.001).

Conclusions: Among patients admitted to cardiac intensive care units with HF-CS, patients with ICM were sicker, less likely to undergo cardiac transplantation, and more likely to die when compared with patients with NICM.

Keywords: Heart failure; cardiogenic shock; cardiomyopathy.