Use of mechanical circulatory support in patients with non-ischaemic cardiogenic shock.

Autor: Schrage B; Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.; German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany., Sundermeyer J; Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.; German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany., Beer BN; Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.; German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany., Bertoldi L; Cardio Center, Humanitas Clinical and Research Center - IRCCS, Milan, Italy., Bernhardt A; German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany.; Department of Cardiothoracic Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany., Blankenberg S; Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.; German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany., Dauw J; Department of Cardiology, Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium.; Doctoral School for Medicine and Life Sciences, LCRC, Diepenbeek, Belgium., Dindane Z; Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany., Eckner D; Department of Cardiology, Paracelsus Medical University Nürnberg, Nürnberg, Germany., Eitel I; German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany.; University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany., Graf T; German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany.; University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany., Horn P; Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany., Kirchhof P; Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.; German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany., Kluge S; University Medical Center Hamburg-Eppendorf, Department of Intensive Care Medicine, Hamburg, Germany., Linke A; Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany., Landmesser U; Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, Germany., Luedike P; Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany., Lüsebrink E; Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany., Mangner N; Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany., Maniuc O; Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany., Winkler SM; Department of Internal Medicine I, University Hospital Jena, Jena, Germany., Nordbeck P; Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany., Orban M; Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany., Pappalardo F; Dept Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy., Pauschinger M; Department of Cardiology, Paracelsus Medical University Nürnberg, Nürnberg, Germany., Pazdernik M; Department of Cardiology, IKEM, Prague, Czech Republic., Proudfoot A; Department of Perioperative Medicine, St. Bartholomew's Hospital, London, UK., Kelham M; Department of Perioperative Medicine, St. Bartholomew's Hospital, London, UK., Rassaf T; Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany., Reichenspurner H; German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany.; Department of Cardiothoracic Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany., Scherer C; Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany., Schulze PC; Department of Internal Medicine I, University Hospital Jena, Jena, Germany., Schwinger RHG; Medizinische Klinik II, Kliniken Nordoberpfalz AG, Weiden, Germany., Skurk C; Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, Germany., Sramko M; Department of Cardiology, IKEM, Prague, Czech Republic., Tavazzi G; Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.; Anesthesia and Intensive Care, Fondazione Policlinico San Matteo Hospital IRCCS, Pavia, Italy., Thiele H; Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany., Villanova L; Unità di Cure Intensive Cardiologiche and De Gasperis Cardio-Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Morici N; IRCCS Santa Maria Nascente Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy., Wechsler A; Medizinische Klinik II, Kliniken Nordoberpfalz AG, Weiden, Germany., Westenfeld R; Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany., Winzer E; Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany., Westermann D; Department of Cardiology and Angiology, University Heart Center, Freiburg, Germany.
Jazyk: angličtina
Zdroj: European journal of heart failure [Eur J Heart Fail] 2023 Apr; Vol. 25 (4), pp. 562-572. Date of Electronic Publication: 2023 Feb 26.
DOI: 10.1002/ejhf.2796
Abstrakt: 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.
(© 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
Databáze: MEDLINE
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