Outcomes, Temporal Trends, and Resource Utilization in Ischemic vs Non-Ischemic Cardiogenic Shock
Lemor A, Dehkordi SHH, Alrayes H, Cowger J, Naidu SS, Villablanca PA, Basir MB, and O'Neill W. Outcomes, Temporal Trends, and Resource Utilization in Ischemic vs Non-Ischemic Cardiogenic Shock. Crit Pathw Cardiol 2021.
Crit Pathw Cardiol
Cardiogenic shock (CS) is associated with significant morbidity and mortality. Differentiating the etiologic factors driving CS has epidemiological significance and aids in optimization of therapeutic strategies, prognostication and resource utilization. The aim herein is to investigate the epidemiology and clinical outcomes of cardiogenic shock in those with ischemic and non-ischemic CS etiologies. Using International Classification of Diseases (ICD) codes, we queried the National Inpatient Sample for cardiogenic shock hospitalization from 2007 to 2018 and divided the study sample into cohorts of ischemic (I-CS) and nonischemic cardiogenic shock. (NI-CS). We then compared the primary outcome of in-hospital mortality between these two cohorts. Two groups of secondary outcomes (clinical and procedural) were also assessed between the two cohorts. CS was present in 557,860 hospitalizations; 84% of these were I-CS and 15.8% NI-CS. Patients with I-CS were older, more commonly males, with more risk factors for coronary artery disease (p<0.05). NI-CS had higher prevalence of pre-existing systolic heart failure and atrial fibrillation. The in-hospital mortality was significantly higher in patients with I-CS (32.2% vs 29.5%, adjOR 1.10, p<0.001). Frequencies of acute ischemic stroke, mechanical ventilation, ventricular arrhythmias, and vascular complications were higher in I-CS vs NI-CS, while AKI and acute liver failure were more common in NI-CS (p<0.05). The use of mechanical circulatory support devices was higher in the I-CS group. In conclusion, patients with I-CS comprise the vast majority of CS, and are associated with higher mortality and higher resource utilization. Conversely, patients with NI-CS appear to have higher survival but with a higher prevalence of end-organ dysfunction.
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