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Predictors of mortality in cardiogenic shock: clinical staging and cardiovascular support
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; Inês Neves; André Lobo; Marta Leite; Rafael Teixeira; Fábio Nunes; Adelaide Dias; Daniel Caeiro; Marisa Silva; Marta Ponte; Pedro Teixeira; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><strong><span style="font-family:"Arial",sans-serif">Background:</span></strong><span style="font-family:Arial,sans-serif"> Cardiogenic shock (CS) is a condition in which cardiac output isn’t enough to meet organ demands.</span><span style="font-family:Calibri,sans-serif"> </span><span style="font-family:Arial,sans-serif">Factors related to mortality are inconsistent in literature.</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 assess comorbidities, clinical presentation, diagnosis, analytic data and CV support in patients with CS and its impact on mortality.</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"> A retrospective study of patients admitted to an intensive cardiac unit in 5 years was conducted (n=6950). Patients with CS were included (n=175). Comorbidities, diagnosis, left ventricular ejection fraction (LVEF) and analytic data at admission, SCAI classification, CV 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 mortality.</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"> Mean age was 66 years and 73% were male. Comorbidities and diagnosis are described in Table 1. Half of the patients had severely reduced LVEF at admission. SCAI classification was A in 14 patients (8%), 28 (16%) in stage B, 65 (37%) in stage C, 41 (23%) in stage D and 27 (15%) in stage E. Vasoactive drugs mainly used were noradrenaline in 144 patients (82%), dobutamine in 75 (46%) and levosimendan in 34 (19%). Mechanical circulatory support used was intra-aortic balloon pump or Impella® in 63 (36%) and extracorporeal membrane oxygenation (ECMO) in 25 (14%) patients. Mortality rate at 30 days was 40% and 45% at 1 year. Mortality at 30 days was associated with age (OR 1.02, p 0.014), SCAI classification (R<sup>2</sup> 0.135, p <0.001), ECMO (OR 2.67, p 0.028), noradrenaline (OR 2.59, p 0.043) and dobutamine (OR 3.44, p < 0.001). Except for the ECMO support, 1-year mortality had the same associations [age (OR 1.04, p <0.001), SCAI classification (R<sup>2</sup> 0.129, p 0.002), noradrenaline (OR 3.07, p 0.016) and dobutamine (OR 2.34, p 0.009)] and temporary pacemaker implantation was also associated (OR 3.05, p 0.008). Aforementioned factors predicted mortality at 30 days and 1-year (p <0.001). Diagnosis, LVEF and analytic data weren’t associated with mortality.</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"> Most patients were SCAI C to E. A high mortality rate was observed and SCAI classification was the strongest predictor. Age and vasoactive drugs were also associated with mortality. ECMO support was associated with 30-day and temporary pacemaker implantation with 1-year mortality. This study emphasizes the importance of staging shock, on top of age, to help decide which and how much CV support to use.</span></span></span></p>
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