Factors associated with acute limb ischemia in cardiogenic shock and downstream clinical outcomes: Insights from the Cardiogenic Shock Working Group

被引：5

作者：

Kochar, Ajar ^{[1
]}

Vallabhajosyula, Saraschandra ^{[2
,3
]}

John, Kevin ^{[4
]}

Sinha, Shashank S. ^{[5
]}

Esposito, Michele ^{[6
]}

Pahuja, Mohit ^{[7
]}

Hirst, Colin ^{[8
]}

Li, Song ^{[9
]}

Kong, Qiuyue ^{[10
]}

Li, Borui ^{[10
]}

Natov, Peter ^{[10
]}

Kanwar, Manreet ^{[11
]}

Hernandez-Montfort, Jaime ^{[12
]}

Garan, A. Reshad ^{[13
]}

Walec, Karol ^{[10
]}

Zazzali, Peter ^{[10
]}

Sangal, Paavni ^{[10
]}

Ton, Van-Khue ^{[14
]}

Zweck, Elric ^{[15
,16
]}

Kataria, Rachna ^{[3
,17
]}

Guglin, Maya ^{[18
]}

Vorovich, Esther ^{[19
]}

Nathan, Sandeep ^{[20
]}

Abraham, Jacob ^{[21
]}

Harwani, Neil M. ^{[10
]}

Fried, Justin A. ^{[22
]}

Farr, Maryjane ^{[23
]}

Hall, Shelley A. ^{[24
]}

Hickey, Gavin W. ^{[25
]}

Wencker, Detlef ^{[12
]}

Schwartzman, Andrew D. ^{[26
]}

Khalife, Wissam ^{[27
]}

Mahr, Claudius ^{[28
]}

Kim, Ju H. ^{[29
]}

Bhimaraj, Arvind ^{[29
]}

Blumer, Vanessa ^{[5
]}

Faugno, Anthony ^{[30
]}

Burkhoff, Daniel ^{[31
]}

Kapur, Navin K.

机构：

[1] Brigham & Womens Hosp, Div Cardiovasc Med, Boston, MA USA

[2] Brown Univ, Cardiovasc Inst, Warren Alpert Med Sch, Providence, RI USA

[3] Lifespan Cardiovasc Inst, Providence, RI USA

[4] Tufts Med Ctr, Cardiovasc Ctr, Boston, MA 02111 USA

[5] INOVA Heart & Vasc Inst, Inova Fairfax Campus, Falls Church, VA USA

[6] Med Univ South Carolina, Div Cardiol, Charleston, SC USA

[7] Univ Oklahoma, Hlth Sci Ctr, Div Cardiol, Oklahoma City, OK USA

[8] St Peters Hlth Partners Med Associates, Div Cardiol, Albany, NY USA

[9] Med City Healthcare, Inst Adv Cardiac Care, Div Cardiol, Dallas, TX USA

[10] Tufts Med Ctr, Cardiovasc Ctr, Div Cardiol, Boston, MA USA

[11] Allegheny Gen Hosp, Gerald McGinnis Cardiovasc Inst, Cardiovasc Inst, Pittsburgh, PA 15122 USA

[12] Baylor Scott & White Hlth, Adv Heart Failure Program Clin, Div Heart & Vasc Care, Temple, TX USA

[13] Beth Israel Deaconess Med Ctr, Div Cardiovasc Med, Boston, MA USA

[14] Massachusetts Gen Hosp, Corrigan Minehan Heart Ctr, Boston, MA USA

[15] Heinrich Heine Univ, Univ Hosp Dusseldorf, Med Fac, Dusseldorf, Germany

[16] Heinrich Heine Univ, Univ Hosp Dusseldorf, Dusseldorf, Germany

[17] Brown Univ, Warren Alpert Med Sch, Div Cardiol, Providence, RI USA

[18] Indiana Univ Sch Med, Krannert Inst Cardiol, Indianapolis, IN 46202 USA

[19] Northwestern Univ, Bluhm Cardiovasc Inst, Ctr Heart Rhythm Disorders, Chicago, IL 60611 USA

[20] Univ Chicago, Div Cardiol, Chicago, IL USA

[21] Providence Heart Inst, Portland, OR USA

[22] Columbia Univ, Irving Med Ctr, Seymour Paul & Gloria Milstein Div Cardiol, New York, NY USA

[23] Univ Texas Southwestern Med Ctr Dallas, Div Cardiol, Dallas, TX USA

[24] Baylor Scott & White, Div Cardiol, Temple, TX USA

[25] Univ Pittsburgh, Med Ctr, Div Neuropathol, Pittsburgh, PA USA

[26] Maine Med Ctr, Div Cardiol, Portland, ME USA

[27] Univ Texas Med Branch, Div Cardiovasc Med, Galveston, TX USA

[28] Univ Washington, Med Ctr, Div Cardiol, Seattle, WA USA

[29] Houston Methodist Res Inst, Dept Cardiol, Houston, TX USA

[30] Tufts Med Ctr, Cardiovasc Ctr, Boston, MA USA

[31] Cardiovasc Res Fdn, New York, NY USA

来源：

JOURNAL OF HEART AND LUNG TRANSPLANTATION | 2024年 / 43卷 / 11期

关键词：

cardiogenic shock; acute limb ischemia; mortality; mechanical circulatory support; ECMO; heart failure; EXTRACORPOREAL MEMBRANE-OXYGENATION; COMPLICATIONS; METAANALYSIS;

D O I：

10.1016/j.healun.2024.06.012

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND: There are limited data depicting the prevalence and ramifications of acute limb ischemia (ALI) among cardiogenic shock (CS) patients. METHODS: We employed data from the Cardiogenic Shock Working Group (CSWG), a consortium including 33 sites. We constructed a multi-variable logistic regression to examine the association between clinical factors and ALI, we generated another logistic regression model to ascertain the association of ALI with mortality. RESULTS: There were 7,070 patients with CS and 399 (5.6%) developed ALI. Patients with ALI were more likely to be female (40.4% vs 29.4%) and have peripheral arterial disease (13.8% vs 8.3%). Stratified by maximum society for cardiovascular angiography & intervention (SCAI) shock stage, the rates of ALI were stage B 0.0%, stage C 1.8%, stage D 4.1%, and stage E 10.3%. Factors associated with higher risk for ALI included: peripheral vascular disease OR 2.24 (95% CI: 1.53-3.23; p < 0.01) and >= 2 mechanical circulatory support (MCS) devices OR 1.66 (95% CI: 1.24-2.21, p < 0.01). ALI was highest for venous-arterial extracorporeal membrane oxygenation (VA-ECMO) patients (11.6%) or VA-ECMO + intra-aortic balloon pump (IABP)/Impella CP (16.6%) yet use of distal perfusion catheters was less than 50%. Mortality was 38.0% for CS patients without ALI but 57.4% for CS patients with ALI. ALI was significantly associated with mortality, adjusted OR 1.40 (95% CI 1.01-1.95, p < 0.01). CONCLUSIONS: The rate of ALI was 6% among CS patients. Factors most associated with ALI include peripheral vascular disease and multiple MCS devices. The downstream ramifications of ALI were dire with a considerably higher risk of mortality. J Heart Lung Transplant 2024;43:1846-1856 (c) 2024 International Society for Heart and Lung Transplantation. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

引用

页码：1846 / 1856

页数：11

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