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Title: | Use of mechanical circulatory support in patients with non-ischaemic cardiogenic shock | Authors: | Schrage, Benedikt Sundermeyer, Jonas Beer, Benedikt Norbert Bertoldi, Letizia Bernhardt, Alexander Blankenberg, Stefan DAUW, Jeroen Dindane, Zouhir Eckner, Dennis Eitel, Ingo Graf, Tobias Horn, Patrick Kirchhof, Paulus Kluge, Stefan Linke, Axel Landmesser, Ulf Luedike, Peter Luesebrink, Enzo Mangner, Norman Maniuc, Octavian Winkler, Sven Moebius Nordbeck, Peter Orban, Martin Pappalardo, Federico Pauschinger, Matthias Pazdernik, Michal Proudfoot, Alastair Kelham, Matthew Rassaf, Tienush Reichenspurner, Hermann Scherer, Clemens Schulze, Paul Christian Schwinger, Robert H. G. Skurk, Carsten Sramko, Marek Tavazzi, Guido Thiele, Holger Villanova, Luca Morici, Nuccia Wechsler, Antonia Westenfeld, Ralf Winzer, Ephraim Westermann, Dirk |
Issue Date: | 2023 | Publisher: | WILEY | Source: | EUROPEAN JOURNAL OF HEART FAILURE, 25, p. 562-572 | Abstract: | Aims Despite its high incidence and mortality risk, there is no evidence-based treatment for non-ischaemic cardiogenic shock (CS). The aim of this study was to evaluate the use of mechanical circulatory support (MCS) for non-ischaemic CS treatment.Methods and results In this multicentre, international, retrospective study, data from 890 patients with non-ischaemic CS, defined as CS due to severe de-novo or acute-on-chronic heart failure with no need for urgent revascularization, treated with or without active MCS, were collected. The association between active MCS use and the primary endpoint of 30-day mortality was assessed in a 1:1 propensity-matched cohort. MCS was used in 386 (43%) patients. Patients treated with MCS presented with more severe CS (37% vs. 23% deteriorating CS, 30% vs. 25% in extremis CS) and had a lower left ventricular ejection fraction at baseline (21% vs. 25%). After matching, 267 patients treated with MCS were compared with 267 patients treated without MCS. In the matched cohort, MCS use was associated with a lower 30-day mortality (hazard ratio 0.76, 95% confidence interval 0.59-0.97). This finding was consistent through all tested subgroups except when CS severity was considered, indicating risk reduction especially in patients with deteriorating CS. However, complications occurred more frequently in patients with MCS; e.g. severe bleeding (16.5% vs. 6.4%) and access-site related ischaemia (6.7% vs. 0%).Conclusion In patients with non-ischaemic CS, MCS use was associated with lower 30-day mortality as compared to medical therapy only, but also with more complications. Randomized trials are needed to validate these findings. [GRAPHICS] | Notes: | Schrage, B (corresponding author), Univ Heart & Vasc Ctr Hamburg, Dept Cardiol, Hamburg, Germany. b.schrage@uke.de |
Keywords: | Cardiogenic shock;Non-ischaemic cardiogenic shock;Mechanical circulatory support | Document URI: | http://hdl.handle.net/1942/39851 | ISSN: | 1388-9842 | e-ISSN: | 1879-0844 | DOI: | 10.1002/ejhf.2796 | ISI #: | 000942612300001 | Rights: | 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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