Cardiogenic shock patients: those with and those without out-of-hospital cardiac arrest are different clinical entities

J Josiassen, O K L Helgestad, J E Moeller, J Kjaergaard, H Schmidt, L O Jensen, L Holmvang, H B Ravn, C Hassager

Publikation: Bidrag til tidsskriftKonferenceabstrakt i tidsskriftForskning

Abstrakt

Cardiogenic shock (CS) due to myocardial infarction (MI) carries 30-day mortality rates as high as 50\of-hospital cardiac arrest (OHCA). Patients with and without OHCA are likely to represent two distinctive entities, which may be problematic to combine in an intervention trial.The aim of the study was to compare CS due to MI patients presenting with and without OHCA in terms of patient characteristics and outcome.In the period from 2010–2017 all patients admitted at two tertiary heart centres in Denmark with CS following MI were individually identified and validated through patient records. The two centres have a catchment area of 3.9 million citizens corresponding to two-thirds of the Danish population.A total of 1716 CS patients were identified, of which 42\mean 63 vs 67 years), more frequently male (85 vs 67\, had higher lactate concentration (median 6.2 vs 5.0 mmol/L) on admission and higher left ventricular ejection fraction (median 30 vs 25\ compared to patients without OHCA (p\lt;0.0001 for all). Patients presenting with OHCA had lower 30-day mortality compared to patients without OHCA (49\7\ respectively, plogrank\lt;0.0001, Figure). Cause of in hospital death differed markedly between the two groups. Not surprisingly, anoxic brain damage was the leading cause of in hospital death in the OHCA group (56\ and only seen in 4\ cardiac failure was the main cause of death in hospital death among patients without OHCA (60\, compared to 27\p\lt;0.0001).Figure 1Among patients with CS due to MI, overall 30-day mortality was significantly lower in patients presenting with OHCA. Anoxic brain damage was the main cause of in hospital death among OHCA patients, whereas fatal heart failure prevailed in patients without OHCA. Combining these two groups in a single trial with one specific intervention seems inappropriate and likely to cause an imbalance in the signal-to-noise ratio.The Danish Heart Foundation and a research grant from Abiomed
OriginalsprogEngelsk
Artikelnummerehz748.0483
TidsskriftEuropean Heart Journal
Vol/bind40
Udgave nummerSuppl. 1
Sider (fra-til)1026
Antal sider1
ISSN0195-668X
DOI
StatusUdgivet - okt. 2019
BegivenhedEuropean Society of Cardiology congress 2019 - Paris, Frankrig
Varighed: 31. aug. 20194. sep. 2019

Konference

KonferenceEuropean Society of Cardiology congress 2019
LandFrankrig
ByParis
Periode31/08/201904/09/2019

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