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A single center analysis exploring mechanical circulatory support in cardiogenic shock
Session:
SESSÃO DE POSTERS 35 - DOENÇAS CARDIOVASCULARES - CHOQUE CARDIOGÉNICO 1
Speaker:
Marta Catarina Almeida
Congress:
CPC 2025
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
14. Acute Cardiac Care
Subtheme:
14.4 Acute Cardiac Care – Cardiogenic Shock
Session Type:
Cartazes
FP Number:
---
Authors:
Marta Catarina Almeida; Jéni Quintal; André Lobo; Inês Neves; Marta Leite; Adelaide Dias; Daniel Caeiro; Marisa Silva; Marta Ponte; Pedro Teixeira; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Background:</span></strong><span style="font-family:"Arial",sans-serif"> Mechanical circulatory support (MCS) is an invasive support strategy in patients with cardiogenic shock (CS). </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Purpose: </span></strong><span style="font-family:"Arial",sans-serif">The aim of the study was to compare CS patients with or without MCS and to identify predictors of implantation.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Methods:</span></strong><span style="font-family:"Arial",sans-serif"> Retrospective analysis of CS patients in an intensive cardiac unit submitted to MCS between 2018 and 2022 was conducted. Comorbidities, diagnosis, left ventricular ejection fraction (LVEF) and analytic data at presentation, SCAI classification, intensive care support and mortality at 30 days and 1 year were registered. Chi-square, t-test and Mann-Whitney tests were used to test the associations. Logistic regression was used to predict implantation of MCS.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Results:</span></strong><span style="font-family:"Arial",sans-serif"> In 175 patients with CS, 74 patients (42%) had MCS, namely 63 (36%) with intra-aortic ballon pump or Impella® heart pump and 25 (14.3%) with extracorporeal membrane oxygenation (ECMO). A comparison of patients with and without MCS use is presented in Table 1. Mean age didn’t show statistically significant differences (68±14.6 in patients without MCS versus 64±13.9 years in patients with MCS, p 0.055). Active smoking (OR 2.218, p 0.013), history of heart failure (OR 0.16, p <0.001), valvular heart disease (OR 0.08, p 0.005) and atrial flutter/fibrillation (OR 0.11, p <0.001) were associated with MCS implantation. Diagnosis (R<sup>2</sup> = 0.128, p <0.001), SCAI classification (R<sup>2</sup> = 0.198, p <0.001), high sensitivity T troponin levels (z = -2.178, p 0.029), invasive ventilation (OR 2.01, p 0.032) and </span></span></span><span style="font-size:12.0pt"><span style="font-family:"Aptos",sans-serif"><span style="color:black">renal replacement therapy (OR 2.71, p 0.038) correlated with MCS implantation"</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Arial",sans-serif">. The above data predicted MCS use (R<sup>2</sup> = 0,426, p <0.001). Mortality outcomes at 30 days and 1 year weren’t significantly different between patients with or without MCS.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Conclusion:</span></strong><span style="font-family:"Arial",sans-serif"> Smokers had higher odds of having MCS support, opposite to patients with history of heart failure, valvular heart disease or atrial flutter/fibrillation. Diagnosis, SCAI classification and troponin levels at admission predicted the implantation of MCS. Patients submitted to invasive ventilation and renal replacement therapy had more than twice the odds of having MCS. Mortality outcomes were similar irrespective of MCS use. Almost half of the prediction of MCS implantation was explained by SCAI classification and it was also associated with mortality, enhancing the focus on staging these patients to assist in timely decision on MCS implantation.</span></span></span></p>
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