Use of mechanical circulatory support in patients with non-ischaemic cardiogenic shock.

1. Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.
Authors
Schrage B^{1,

3}
Sundermeyer J^{1,

3}
Beer BN^{1,

3}
Blankenberg S^{1,

3}
Kirchhof P^{1,

3}
(5 authors)
2. Cardio Center, Humanitas Clinical and Research Center - IRCCS, Milan, Italy.
Authors
Bertoldi L²
(1 author)
3. German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany.
Authors
Schrage B^{1,

3}
Sundermeyer J^{1,

3}
Beer BN^{1,

3}
Bernhardt A³
Blankenberg S^{1,

3}
Eitel I³
Graf T³
Kirchhof P^{1,

3}
Reichenspurner H³
(9 authors)
4. Department of Cardiology, Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium.
Authors
Dauw J⁴
(1 author)
5. Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany.
Authors
Dindane Z⁵
Linke A⁵
Mangner N⁵
Winzer E⁵
(4 authors)

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European Journal of Heart Failure, 26 Feb 2023, 25(4):562-572
https://doi.org/10.1002/ejhf.2796 PMID: 36781178

A comment on this article appears in "For the best management, please ask for assistance!" Eur J Heart Fail. 2023 Apr;25(4):573-575.

Abstract

Aims

Despite its high incidence and mortality risk, there is no evidence-based treatment for non-ischaemic cardiogenic shock (CS). The aim of this study was to evaluate the use of mechanical circulatory support (MCS) for non-ischaemic CS treatment.

Methods and results

In this multicentre, international, retrospective study, data from 890 patients with non-ischaemic CS, defined as CS due to severe de-novo or acute-on-chronic heart failure with no need for urgent revascularization, treated with or without active MCS, were collected. The association between active MCS use and the primary endpoint of 30-day mortality was assessed in a 1:1 propensity-matched cohort. MCS was used in 386 (43%) patients. Patients treated with MCS presented with more severe CS (37% vs. 23% deteriorating CS, 30% vs. 25% in extremis CS) and had a lower left ventricular ejection fraction at baseline (21% vs. 25%). After matching, 267 patients treated with MCS were compared with 267 patients treated without MCS. In the matched cohort, MCS use was associated with a lower 30-day mortality (hazard ratio 0.76, 95% confidence interval 0.59-0.97). This finding was consistent through all tested subgroups except when CS severity was considered, indicating risk reduction especially in patients with deteriorating CS. However, complications occurred more frequently in patients with MCS; e.g. severe bleeding (16.5% vs. 6.4%) and access-site related ischaemia (6.7% vs. 0%).

Conclusion

In patients with non-ischaemic CS, MCS use was associated with lower 30-day mortality as compared to medical therapy only, but also with more complications. Randomized trials are needed to validate these findings.

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