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Patient Characteristics, Treatment and Outcome in Non-Ischemic vs. Ischemic Cardiogenic Shock

Aim: Evidence on non-ischemic cardiogenic shock (CS) is scarce. The aim of this study was to investigate differences in patient characteristics, use of treatments and outcomes in patients with non-ischemic vs. ischemic CS. Methods: Patients with CS admitted between October 2009 and October 2017 were...

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Autores principales: Schrage, Benedikt, Weimann, Jessica, Dabboura, Salim, Yan, Isabell, Hilal, Rafel, Becher, Peter Moritz, Seiffert, Moritz, Bernhardt, Alexander M., Kluge, Stefan, Reichenspurner, Hermann, Blankenberg, Stefan, Westermann, Dirk
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230560/
https://www.ncbi.nlm.nih.gov/pubmed/32231121
http://dx.doi.org/10.3390/jcm9040931
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author Schrage, Benedikt
Weimann, Jessica
Dabboura, Salim
Yan, Isabell
Hilal, Rafel
Becher, Peter Moritz
Seiffert, Moritz
Bernhardt, Alexander M.
Kluge, Stefan
Reichenspurner, Hermann
Blankenberg, Stefan
Westermann, Dirk
author_facet Schrage, Benedikt
Weimann, Jessica
Dabboura, Salim
Yan, Isabell
Hilal, Rafel
Becher, Peter Moritz
Seiffert, Moritz
Bernhardt, Alexander M.
Kluge, Stefan
Reichenspurner, Hermann
Blankenberg, Stefan
Westermann, Dirk
author_sort Schrage, Benedikt
collection PubMed
description Aim: Evidence on non-ischemic cardiogenic shock (CS) is scarce. The aim of this study was to investigate differences in patient characteristics, use of treatments and outcomes in patients with non-ischemic vs. ischemic CS. Methods: Patients with CS admitted between October 2009 and October 2017 were identified and stratified as non-ischemic/ischemic CS based on the absence/presence of acute myocardial infarction. Logistic/Cox regression models were fitted to investigate the association between non-ischemic CS and patient characteristics, use of treatments and 30-day in-hospital mortality. Results: A total of 978 patients were enrolled in this study; median age was 70 (interquartile range 58, 79) years and 70% were male. Of these, 505 patients (52%) had non-ischemic CS. Patients with non-ischemic CS were more likely to be younger and female; were less likely to be active smokers, to have diabetes or decreased renal function, but more likely to have a history of myocardial infarction; and they were more likely to present with unfavorable hemodynamics and with mechanical ventilation. Regarding treatments, patients with non-ischemic CS were more likely to be treated with catecholamines, but less likely to be treated with extracorporeal membrane oxygenation or percutaneous left-ventricular assist devices. After adjustment for multiple relevant confounders, non-ischemic CS was associated with a significant increase in the risk of 30-day in-hospital mortality (hazard ratio 1.14, 95% confidence interval 1.04–1.24, p < 0.01). Conclusion: In this large study, non-ischemic CS accounted for more than 50% of all CS cases. Non-ischemic CS was not only associated with relevant differences in patient characteristics and use of treatments, but also with a worse prognosis. These findings highlight the need for effective treatment strategies for patients with non-ischemic CS.
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spelling pubmed-72305602020-05-22 Patient Characteristics, Treatment and Outcome in Non-Ischemic vs. Ischemic Cardiogenic Shock Schrage, Benedikt Weimann, Jessica Dabboura, Salim Yan, Isabell Hilal, Rafel Becher, Peter Moritz Seiffert, Moritz Bernhardt, Alexander M. Kluge, Stefan Reichenspurner, Hermann Blankenberg, Stefan Westermann, Dirk J Clin Med Article Aim: Evidence on non-ischemic cardiogenic shock (CS) is scarce. The aim of this study was to investigate differences in patient characteristics, use of treatments and outcomes in patients with non-ischemic vs. ischemic CS. Methods: Patients with CS admitted between October 2009 and October 2017 were identified and stratified as non-ischemic/ischemic CS based on the absence/presence of acute myocardial infarction. Logistic/Cox regression models were fitted to investigate the association between non-ischemic CS and patient characteristics, use of treatments and 30-day in-hospital mortality. Results: A total of 978 patients were enrolled in this study; median age was 70 (interquartile range 58, 79) years and 70% were male. Of these, 505 patients (52%) had non-ischemic CS. Patients with non-ischemic CS were more likely to be younger and female; were less likely to be active smokers, to have diabetes or decreased renal function, but more likely to have a history of myocardial infarction; and they were more likely to present with unfavorable hemodynamics and with mechanical ventilation. Regarding treatments, patients with non-ischemic CS were more likely to be treated with catecholamines, but less likely to be treated with extracorporeal membrane oxygenation or percutaneous left-ventricular assist devices. After adjustment for multiple relevant confounders, non-ischemic CS was associated with a significant increase in the risk of 30-day in-hospital mortality (hazard ratio 1.14, 95% confidence interval 1.04–1.24, p < 0.01). Conclusion: In this large study, non-ischemic CS accounted for more than 50% of all CS cases. Non-ischemic CS was not only associated with relevant differences in patient characteristics and use of treatments, but also with a worse prognosis. These findings highlight the need for effective treatment strategies for patients with non-ischemic CS. MDPI 2020-03-28 /pmc/articles/PMC7230560/ /pubmed/32231121 http://dx.doi.org/10.3390/jcm9040931 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Schrage, Benedikt
Weimann, Jessica
Dabboura, Salim
Yan, Isabell
Hilal, Rafel
Becher, Peter Moritz
Seiffert, Moritz
Bernhardt, Alexander M.
Kluge, Stefan
Reichenspurner, Hermann
Blankenberg, Stefan
Westermann, Dirk
Patient Characteristics, Treatment and Outcome in Non-Ischemic vs. Ischemic Cardiogenic Shock
title Patient Characteristics, Treatment and Outcome in Non-Ischemic vs. Ischemic Cardiogenic Shock
title_full Patient Characteristics, Treatment and Outcome in Non-Ischemic vs. Ischemic Cardiogenic Shock
title_fullStr Patient Characteristics, Treatment and Outcome in Non-Ischemic vs. Ischemic Cardiogenic Shock
title_full_unstemmed Patient Characteristics, Treatment and Outcome in Non-Ischemic vs. Ischemic Cardiogenic Shock
title_short Patient Characteristics, Treatment and Outcome in Non-Ischemic vs. Ischemic Cardiogenic Shock
title_sort patient characteristics, treatment and outcome in non-ischemic vs. ischemic cardiogenic shock
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230560/
https://www.ncbi.nlm.nih.gov/pubmed/32231121
http://dx.doi.org/10.3390/jcm9040931
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