Differences between cardiogenic shock related to acute decompensated heart failure and acute myocardial infarction
Bertaina, Maurizio (San Giovanni Bosco Hospital(Itàlia))
Morici, Nuccia (IRCCS S. Maria Nascente - Fondazione Don Carlo Gnocchi ONLUS)
Frea, Simone (AOU Città della Salute e della Scienza di Torino)
Garatti, Laura (ASST Grande Ospedale Metropolitano Niguarda (Itàlia))
Briani, Martina (Humanitas Research Hospital (Itàlia))
Sorini, Carlotta (University of Siena (Itàlia))
Villanova, Luca (ASST Grande Ospedale Metropolitano Niguarda (Itàlia))
Corrada, Elena (Humanitas Research Hospital (Itàlia))
Sacco, Alice (ASST Grande Ospedale Metropolitano Niguarda (Itàlia))
Moltrasio, Marco (Centro Cardiologico Monzino IRCCS (Itàlia))
Ravera, Amelia (S. Giovanni Di Dio e Ruggi D'Aragona Hospital (Itàlia))
Tedeschi, Michele (S. Giovanni Di Dio e Ruggi D'Aragona Hospital)
Bertoldi, Letizia Fausta (Humanitas Research Hospital (Itàlia))
Lettino, Maddalena (Ospedale San Gerardo (Itàlia))
Saia, Francesco (IRCCS Azienda Ospedaliero-Universitaria di Bologna (Itàlia))
Corsini, Anna (IRCCS Azienda Ospedaliero-Universitaria di Bologna (Itàlia))
Camporotondo, Rita (Fondazione Policlinico San Matteo Hospital IRCCS (Itàlia))
Colombo, Costanza Natalia Julia (Fondazione Policlinico San Matteo Hospital IRCCS (Itàlia))
Bertolin, Stephanie (Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo)
Rota, Matteo (University of Brescia (Itàlia))
Oliva, Fabrizio (ASST Grande Ospedale Metropolitano Niguarda (Itàlia))
Iannaccone, Mario (San Giovanni Bosco Hospital (Itàlia))
Valente, Serafina (University of Siena (Itàlia))
Pagnesi, Matteo (University of Brescia (Itàlia))
Metra, Marco (University of Brescia (Itàlia))
Sionis, Alessandro (Institut d'Investigació Biomèdica Sant Pau)
Marini, Marco (Ospedali Riuniti (Itàlia))
De Ferrari, Gaetano Maria (University of Torino (Itàlia))
Kapur, Navin K. (Tufts Medical Center (Estats Units d'Amèrica))
Pappalardo, Federico (Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo)
Tavazzi, Guido (Fondazione Policlinico San Matteo Hospital IRCCS (Itàlia))
Universitat Autònoma de Barcelona

Data:	2023
Resum:	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). 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). 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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Cardiogenic shock ; Heart failure ; Mortality ; Myocardial infarction
Publicat a:	ESC Heart Failure, Vol. 10 Núm. 6 (december 2023) , p. 3472-3482, ISSN 2055-5822

DOI: 10.1002/ehf2.14510
PMID: 37723131

11 p, 671.0 KB

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