Ten-year trends in characteristics, management and outcomes of patients admitted with cardiogenic shock in the ACTION-SHOCK cohort - 17/10/24
, Michel Zeitouni afor the ACTION group2
Graphical abstract |
Highlights |
• | During 2011–2020, the characteristics of patients admitted for CS generally remained stable. |
• | Rescue ECMO use remained stable, IABP use decreased, and Impella use remained rare. |
• | Access to heart transplantation and use of ventricular assist devices did not improve. |
• | Despite new cardioprotective drugs, these were challenging to implement during hospitalization. |
• | There were no improvements in survival or readmission for acute heart failure. |
Abstract |
Background |
The ACTION-SHOCK registry offers a decade-long perspective on patients admitted with cardiogenic shock (CS).
Aims |
To assess trends in the management and outcomes of patients with CS over 10 years.
Methods |
Trends in the characteristics, management and outcomes of patients with CS admitted into the cardiac intensive care unit of Pitié-Salpêtrière hospital from 2011 to 2020 were analysed. Short-term outcomes included in-hospital mortality, heart transplantation or ventricular assist device. Long-term outcomes were all-cause death or readmission for acute heart failure at 1 year.
Results |
Over a 10-year period, data from 700 patients with CS (median [interquartile range] age 61 [50–72] years; 73% of men) were analysed. The proportion of CS related to acute myocardial infarction decreased (from 45% in 2011–2012 to 27% in 2019–2020) while the proportions related to chronic coronary syndrome (18% to 23%) and non-ischaemic cardiomyopathies (37 to 51%) increased (P<0.01). The use of rescue extracorporeal membrane oxygenation remained stable (19 to 14%) and intra-aortic balloon pump use decreased (22% to 7%) (P<0.01). In-hospital mortality remained stable (27 to 29%) as did the proportions of patients discharged after transplantation (17 to 14%) or with a durable ventricular assist device (2 to 4%). Among patients discharged alive, death or readmission for acute heart failure at 1 year remained high (37 to 47%).
Conclusion |
CS remained associated with a poor prognosis over the last decade. There are significant unmet needs in the management strategies of patients with CS.
Le texte complet de cet article est disponible en PDF.Keywords : Cardiogenic shock, Heart failure, Cardiac intensive care unit, Management, Extracorporeal membrane oxygenation
Plan
Vol 117 - N° 10
P. 569-576 - octobre 2024 Retour au numéro
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