Characteristics, Treatment Strategies and Outcome in Cardiogenic Shock Complicating Acute Myocardial Infarction: A Contemporary Dutch Cohort

Author:

Peters Elma J.1,Berg Sanne ten1,Bogerd Margriet1,Timmermans Marijke J. C.2ORCID,Kraaijeveld Adriaan O.3,Bunge Jeroen J. H.45,Teeuwen Koen6,Lipsic Erik7,Sjauw Krischan D.8,Geuns Robert-Jan M. van9,Dedic Admir10,Dubois Eric A.45,Meuwissen Martijn11,Danse Peter12,Verouden Niels J. W.1,Bleeker Gabe13,Cabezas José M. Montero14,Ferreira Irlando A.15,Engström Annemarie E.16,Lagrand Wim K.16ORCID,Otterspoor Luuk C.517,Vlaar Alexander P. J.16ORCID,Henriques José P. S.1ORCID,

Affiliation:

1. Heart Center, Department of Cardiology, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands

2. Netherlands Heart Registration, 3511 EP Utrecht, The Netherlands

3. Department of Cardiology, Utrecht University Medical Center, 3584 CX Utrecht, The Netherlands

4. Department of Cardiology, Thoraxcenter, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands

5. Department of Intensive Care Adults, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands

6. Heart Center, Department of Interventional Cardiology, Catharina Hospital Eindhoven, 5623 EJ Eindhoven, The Netherlands

7. Department of Cardiology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands

8. Heart Center, Medical Center Leeuwarden, 8934 AD Leeuwarden, The Netherlands

9. Department of Cardiology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands

10. Department of Cardiology, Noordwest Clinics, 1815 JD Alkmaar, The Netherlands

11. Department of Cardiology, Amphia Hospital, 4818 CK Breda, The Netherlands

12. Department of Cardiology, Rijnstate Hospital, 6815 AD Arnhem, The Netherlands

13. Department of Cardiology, Haga Hospital, 2545 AA The Hague, The Netherlands

14. Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands

15. Department of Cardiology, Isala Hospital, 8025 AB Zwolle, The Netherlands

16. Department of Intensive Care, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands

17. Department of Intensive Care, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands

Abstract

Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) is associated with high morbidity and mortality. Our study aimed to gain insights into patient characteristics, outcomes and treatment strategies in CS patients. Patients with CS who underwent percutaneous coronary intervention (PCI) between 2017 and 2021 were identified in a nationwide registry. Data on medical history, laboratory values, angiographic features and outcomes were retrospectively assessed. A total of 2328 patients with a mean age of 66 years and of whom 73% were male, were included. Mortality at 30 days was 39% for the entire cohort. Non-survivors presented with a lower mean blood pressure and increased heart rate, blood lactate and blood glucose levels (p-value for all <0.001). Also, an increased prevalence of diabetes, multivessel coronary artery disease and a prior coronary event were found. Of all patients, 24% received mechanical circulatory support, of which the majority was via intra-aortic balloon pumps (IABPs). Furthermore, 79% of patients were treated with at least one vasoactive agent, and multivessel PCI was performed in 28%. In conclusion, a large set of hemodynamic, biochemical and patient-related characteristics was identified to be associated with mortality. Interestingly, multivessel PCI and IABPs were frequently applied despite a lack of evidence.

Publisher

MDPI AG

Subject

General Medicine

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