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

被引：19

作者：

Bertaina, Maurizio ^{[1
]}

Morici, Nuccia ^{[2
]}

Frea, Simone ^{[3
]}

Garatti, Laura ^{[4
,5
]}

Briani, Martina ^{[6
]}

Sorini, Carlotta ^{[7
]}

Villanova, Luca ^{[4
,5
]}

Corrada, Elena ^{[6
]}

Sacco, Alice ^{[4
,5
]}

Moltrasio, Marco ^{[8
]}

Ravera, Amelia ^{[9
]}

Tedeschi, Michele ^{[9
]}

Bertoldi, Letizia ^{[6
]}

Lettino, Maddalena ^{[10
]}

Saia, Francesco ^{[11
]}

Corsini, Anna ^{[11
]}

Camporotondo, Rita ^{[12
]}

Colombo, Costanza Natalia Julia ^{[12
]}

Bertolin, Stephanie ^{[13
]}

Rota, Matteo ^{[14
,15
]}

Oliva, Fabrizio ^{[4
,5
]}

Iannaccone, Mario ^{[1
]}

Valente, Serafina ^{[7
]}

Pagnesi, Matteo ^{[16
]}

Metra, Marco ^{[16
]}

Sionis, Alessandro ^{[17
]}

Marini, Marco ^{[18
]}

De Ferrari, Gaetano Maria ^{[3
,19
]}

Kapur, Navin K. ^{[20
]}

Pappalardo, Federico ^{[13
]}

Tavazzi, Guido ^{[21
,22
]}

机构：

[1] San Giovanni Bosco Hosp, Div Cardiol, ASL Citta Torino, Turin, Italy

[2] IRCCS S Maria Nascente, Fdn Don Carlo Gnocchi ONLUS, Milan, Italy

[3] Citta Salute & Sci Torino, Intens Cardiac Care Unit, Turin, Italy

[4] ASST Grande Osped Metropolitano Niguarda, Cardiol Dept, Milan, Italy

[5] ASST Grande Osped Metropolitano Niguarda, De Gasperis Cardio Ctr, Milan, Italy

[6] IRCCS Rozzano, Humanitas Res Hosp, Milan, Italy

[7] Univ Siena, Dept Med Biotechnol, Div Cardiol, Siena, Italy

[8] Ctr Cardiol Monzino IRCCS, Milan, Italy

[9] S Giovanni Di Dio & Ruggi DAragona Hosp, Cardiol Dept, Intens Care Unit, Salerno, Italy

[10] ASST Monza, San Gerardo Hosp, Cardiovasc Dept, Monza, Italy

[11] IRCCS Azienda Osped Univ Bologna, Cardiol Unit, Bologna, Italy

[12] Fdn Policlin San Matteo Hosp IRCCS, Intens Cardiac Care Unit, Pavia, Italy

[13] AO SS Antonio & Biagio & Cesare Arrigo, Cardiothorac & Vasc Anesthesia & Intens Care, Alessandria, Italy

[14] Univ Brescia, Dept Mol & Translat Med, Unit Biostat, Brescia, Italy

[15] Univ Brescia, Dept Mol & Translat Med, Units Biomath & Bioinformat, Brescia, Italy

[16] Univ Brescia, Dept Med & Surg Specialties, Rad Sci & Publ Hlth, Cardiothorac Dept,Civil Hosp,Cardiol, Brescia, Italy

[17] Hosp Santa Creu i Sant Pau, Intens Cardiac Care Unit, Cardiol Dept, Barcelona, Spain

[18] Osped Riuniti, Dept Cardiovasc Sci, Div Cardiol & ICCU, Ancona, Italy

[19] Univ Torino, Dept Med Sci, Turin, Italy

[20] Tufts Med Ctr, CardioVasc Ctr, Boston, MA USA

[21] Univ Pavia, Dept Clin Surg Diagnost & Paediat Sci, Pavia, Italy

[22] Fdn Policlin San Matteo Hosp IRCCS, Anesthesia & Intens Care, Anestesia & Rianimaz 1, Pavia, Italy

来源：

ESC HEART FAILURE | 2023年 / 10卷 / 06期

关键词：

Cardiogenic shock; Heart failure; Myocardial infarction; Mortality; TRIALS;

D O I：

10.1002/ehf2.14510

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：3472 / 3482

页数：11

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