Comparison of in-hospital outcomes of patients with vs. without ischaemic cardiomyopathy undergoing veno-arterial-extracorporeal membrane oxygenation

Seok-Woo Seong, Guiyue Jin, Mijoo Kim, Kye Taek Ahn, Jeong Hoon Yang, Hyeon-Cheol Gwon, Young-Guk Ko, Cheol Woong Yu, Woo Jung Chun, Woo Jin Jang, Hyun-Joong Kim, Jang-Whan Bae, Sung Uk Kwon, Hyun-Jong Lee, Wang Soo Lee, Sang-Don Park, Sung Soo Cho, Joong Hyun Ahn, Pil Sang Song, Jin-Ok Jeong, Seok-Woo Seong, Guiyue Jin, Mijoo Kim, Kye Taek Ahn, Jeong Hoon Yang, Hyeon-Cheol Gwon, Young-Guk Ko, Cheol Woong Yu, Woo Jung Chun, Woo Jin Jang, Hyun-Joong Kim, Jang-Whan Bae, Sung Uk Kwon, Hyun-Jong Lee, Wang Soo Lee, Sang-Don Park, Sung Soo Cho, Joong Hyun Ahn, Pil Sang Song, Jin-Ok Jeong

Abstract

Aims: This study aimed to investigate differences in baseline and treatment characteristics, and in-hospital mortality according to the aetiologies of cardiogenic shock in patients undergoing veno-arterial-extracorporeal membrane oxygenation (VA-ECMO).

Methods and results: The RESCUE registry is a multicentre, observational cohort that includes 1247 patients with cardiogenic shock from 12 centres. A total of 496 patients requiring VA-ECMO were finally selected, and the study population was stratified by cardiogenic shock aetiology [ischaemic cardiomyopathy (ICM, n = 342) and non-ICM (NICM, n = 154)]. The primary outcome of interest was in-hospital mortality. Sensitivity analyses including propensity-score matching adjustments were performed. Mean age of the entire population was 61.8 ± 14.2, and 30.8% were women. There were significant differences in baseline characteristics; notable differences included the older age of patients with ICM (65.1 ± 13.7 vs. 58.2 ± 13.8, P < 0.001), preponderance of males [258 (75.4%) vs. 85 (55.2%), P < 0.001], and higher prevalence of diabetes mellitus [140 (40.9%) vs. 39 (25.3%), P = 0.001] compared with patients in the NICM aetiology group. Patients with ischaemic cardiogenic shock were more likely to have longer shock duration before VA-ECMO implantation (518.7 ± 941.4 min vs. 292.4 ± 707.8 min, P = 0.003) and were less likely to undergo distal limb perfusion than those with NICM [108 (31.6%) vs. 79 (51.3%), P < 0.001]. In-hospital mortality in the overall cohort was 52.2%; patients with ICM had a higher unadjusted risk of in-hospital mortality [203 (59.4%) vs. 56 (36.4%); unadjusted hazard ratio, 2.295; 95% confidence interval, 1.698-3.100; P < 0.001]. There were no significant differences in the primary outcome between the two aetiologies following propensity-score matching multiple adjustments (adjusted hazard ratio, 1.265; 95% confidence interval, 0.840-1.906; P = 0.260).

Conclusions: Results of the current study indicated among patients with cardiogenic shock undergoing VA-ECMO, ischaemic aetiology does not seem to impact in-hospital mortality. These findings underline that early initiation and appropriate treatment strategies of VA-ECMO for patients with ICM shock are required.

Trial registration: ClinicalTrials.gov NCT02985008.

Keywords: Cardiogenic shock; ECMO; Ischaemic cardiomyopathy; Non-ischaemic cardiomyopathy.

Conflict of interest statement

The authors have no conflicts of interest to declare.

© 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

Figures

Figure 1
Figure 1
Time‐to‐event curves for in‐hospital mortality in the overall cohort of patients (A) and in the propensity‐score matched cohort of patients (B) managed with a VA‐ECMO. ICM, ischaemic cardiomyopathy; NICM, non‐ischaemic cardiomyopathy; VA‐ECMO, veno‐arterial‐extracorporeal membrane oxygenation.

References

    1. van Diepen S, Katz JN, Albert NM, Henry TD, Jacobs AK, Kapur NK, Kilic A, Menon V, Ohman EM, Sweitzer NK, Thiele H, Washam JB, Cohen MG, American Heart Association Council on Clinical Cardiology , Council on Cardiovascular and Stroke Nursing , Council on Quality of Care and Outcomes Research , Mission: Lifeline . Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association. Circulation 2017; 136: e232–e268.
    1. Jenča D, Melenovský V, Stehlik J, Staněk V, Kettner J, Kautzner J, Adámková V, Wohlfahrt P. Heart failure after myocardial infarction: incidence and predictors. ESC Heart Fail 2021; 8: 222–237.
    1. Mandawat A, Rao SV. Percutaneous mechanical circulatory support devices in cardiogenic shock. Circ Cardiovasc Interv 2017; 10: e004337.
    1. Schrage B, Becher PM, Goßling A, Savarese G, Dabboura S, Yan I, Beer B, Söffker G, Seiffert M, Kluge S, Kirchhof P, Blankenberg S, Westermann D. Temporal trends in incidence, causes, use of mechanical circulatory support and mortality in cardiogenic shock. ESC Heart Fail 2021; 8: 1295–1303.
    1. Eckman PM, Katz JN, El Banayosy A, Bohula EA, Sun B, van Diepen S. Veno‐arterial extracorporeal membrane oxygenation for cardiogenic shock: an introduction for the busy clinician. Circulation 2019; 140: 2019–2037.
    1. Lemogoum D, Kamdem F, Ba H, Ngatchou W, Hye Ndindjock G, Dzudie A, Monkam Y, Mouliom S, Hermans MP, Bika Lele EC, van de Borne P. Epidemiology of acutely decompensated systolic heart failure over the 2003‐2013 decade in Douala General Hospital, Cameroon. ESC Heart Fail 2021; 8: 481–488.
    1. Wilcox JE, Fang JC, Margulies KB, Mann DL. Heart failure with recovered left ventricular ejection fraction: JACC Scientific Expert Panel. J Am Coll Cardiol 2020; 76: 719–734.
    1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González‐Juanatey JR, Harjola V‐P, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, ESC Scientific Document Group . 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37: 2129–2200.
    1. Cook JL, Colvin M, Francis GS, Grady KL, Hoffman TM, Jessup M, John R, Kiernan MS, Mitchell JE, Pagani FD, Petty M, Ravichandran P, Rogers JG, Semigran MJ, Toole JM, American Heart Association Heart Failure and Transplantation Committee of the Council on Clinical Cardiology , Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation , Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing , Council on Cardiovascular Radiology and Intervention , Council on Cardiovascular Surgery and Anesthesia . Recommendations for the use of mechanical circulatory support: ambulatory and community patient care: a scientific statement from the American Heart Association. Circulation 2017; 135: e1145–e1158.
    1. Neumann F‐J, Sousa‐Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet J‐P, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO, ESC Scientific Document Group . 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J 2019; 40: 87–165.
    1. Austin PC, Stuart EA. Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med 2015; 34: 3661–3679.
    1. Han J, Pinsino A, Sanchez J, Takayama H, Garan AR, Topkara VK, Naka Y, Demmer RT, Kurlansky PA, Colombo PC, Takeda K, Yuzefpolskaya M. Prognostic value of vasoactive‐inotropic score following continuous flow left ventricular assist device implantation. J Heart Lung Transplant 2019; 38: 930–938.
    1. Shore S, Grau‐Sepulveda MV, Bhatt DL, Heidenreich PA, Eapen ZJ, Hernandez AF, Yancy CW, Fonarow GC. Characteristics, treatments, and outcomes of hospitalized heart failure patients stratified by etiologies of cardiomyopathy. JACC Heart Fail 2015; 3: 906–916.
    1. Batra J, Toyoda N, Goldstone AB, Itagaki S, Egorova NN, Chikwe J. Extracorporeal membrane oxygenation in New York State: trends, outcomes, and implications for patient selection. Circ Heart Fail 2016; 9: e003179.
    1. Acharya D, Torabi M, Borgstrom M, Rajapreyar I, Lee K, Kern K, Rycus P, Tonna JE, Alexander P, Lotun K. Extracorporeal membrane oxygenation in myocardial infarction complicated by cardiogenic shock: analysis of the ELSO registry. J Am Coll Cardiol 2020; 76: 1001–1002.
    1. Schmidt M, Burrell A, Roberts L, Bailey M, Sheldrake J, Rycus PT, Hodgson C, Scheinkestel C, Cooper DJ, Thiagarajan RR, Brodie D, Pellegrino V, Pilcher D. Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno‐arterial‐ECMO (SAVE)‐score. Eur Heart J 2015; 36: 2246–2256.
    1. Juo YY, Skancke M, Sanaiha Y, Mantha A, Jimenez JC, Benharash P. Efficacy of distal perfusion cannulae in preventing limb ischemia during extracorporeal membrane oxygenation: a systematic review and meta‐analysis. Artif Organs 2017; 41: E263–E273.
    1. Felker GM, Shaw LK, O'Connor CM. A standardized definition of ischemic cardiomyopathy for use in clinical research. J Am Coll Cardiol 2002; 39: 210–218.
    1. Ogundimu EO, Altmar DG, Collins GS. Adequate sample size for developing prediction models is not simply related to events per variable. J Clin Epidemiol 2016; 76: 175–182.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir