Predictive factors for long-term mortality and role of comorbidities in cardiogenic shock.

Autor: Orloff, E., Bouisset, F., Elbaz, M., Moine, T., Biendel, C., Carrie, D., Galinier, M., Lairez, O., Delmas, C.
Zdroj: Archives of Cardiovascular Diseases Supplements; Jan2018, Vol. 10 Issue 1, p151-152, 2p
Abstrakt: Background Despite advances in intensive care medicine, the treatment of cardiogenic shock (CS) is still far from perfect with high residual mortality rates regardless of etiology. Predictive data regarding long-term (LT) mortality rates in patients presenting CS is sparse. Aims Early detection of high-risk patients is a major challenge to intensify the management and improve the outcomes even in the LT. Methods In total, 275 CS patients admitted to our center (CHU de Toulouse) between 01/2013 and 12/2014 were retrospectively reviewed. Mortality was recorded by telephone in 12/2016. The cox proportional hazards model was used to determine LT predictors of mortality. Results Patients were male (76%) with an average age of 64 (± 15.5) and a history of cardiomyopathy (63%) mainly ischemic (42%). Leading causes of CS were post-myocardial infarction (35%) decompensated heart failure (34%), and post-cardiac arrest (21%). On December 2016, the mortality rate was 62.5%. After multivariate analysis, we identified prior use of beta-blockers (HR: 0.62 [95% CI: 0.42–0.91]; P = 0.02) and initial coronary angiography exploration (HR: 0.60 [95% CI: 0.4–0.92]; P = 0.02) as protective factors. Conversely, age (HR: 1.02 per year [95% CI: 1.01–1.04]; P < 0.001), catecholamine support (HR: 1.37 for one additional agent more [95% CI: 1.19–1.57]; P < 0.001), and renal replacement support (HR: 1.64 [95% CI: 1.07–2.51]; P = 0.02) were associated with increased LT mortality ( Fig. 1 ). Conclusion The LT mortality of CS remains high. In terms of LT survival, prior use of beta-blockers and coronary angiography exploration has a protective role, while age, renal insufficiency, and use of inotropic agents, seem to worsen the prognosis. [ABSTRACT FROM AUTHOR]
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