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Abstract 15767: Association of Invasive Hemodynamic Evaluation With 3- and 6-Months Survival in Patients Treated for Cardiogenic Shock
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Abstract 15767: Association of Invasive Hemodynamic Evaluation With 3- and 6-Months Survival in Patients Treated for Cardiogenic Shock

Muhammad Khalid, Ahmed Abdelhamid, Rupesh Kshetri and Ernesto A Ruiz
Circulation (New York, N.Y.), Vol.146(Suppl_1), p.A15767
11/08/2022
DOI: 10.1161/circ.146.suppl_1.15767
url
https://doi.org/10.1161/circ.146.suppl_1.15767View
Published (Version of record) Open Access

Abstract

Abstract only Introduction: Cardiogenic shock (CS) is a complex spectrum of low output states which can occur in the setting of Acute Coronary Syndrome (ACS) or Acute Decompensated Heart Failure (ADHF). Its management is guided by frequent hemodynamic assessment and prompt treatment without which the mortality rate ranges from 27% to 51%. Contemporary data suggests that the use of right heart catheterization (RHC) improves in-hospital mortality and survival of patients. Our study aims to compare the difference in survival at 3 and 6 months based on RHC. Methods: A single center retrospective analysis was performed on patients admitted with CS secondary to ACS or ADHF from 7/01/2018 till 6/30/2020 at the University of Iowa. Patients were identified by the International Classification of Diseases 10th Revision Clinical Modification (ICD-10 CM) codes and were risk-stratified using the Society of Cardiovascular Angiography & Interventions (SCAI) Shock Classification. 3 and 6 months survival analysis was done with the help of Log Rank test and Kaplan Meier survival curves. RHC was also evaluated as a predictor by Cox Regression analysis among all SCAI groups. Results: 647 patients admitted with CS, 249 patients underwent RHC during their admission. 51 had ACS and 198 had isolated ADHF as the precipitating cause of CS in patients who underwent invasive assessment. Evaluation by RHC showed improved 3 months survival in patients with SCAI 2 (p<0.01), SCAI3 (p=0.01) and SCAI 5 CS (<0.01). The association was significant at 6 months in SCAI 2 (p<0.01), and SCAI 5 CS (<0.01). RHC was a significant predictor of improved survival in SCAI 2 (HR 0.23; p=0.03; 95% CI 0.06 - 0.9), SCAI 3 (HR 0.26; p=0.01; 95% CI 0.08 - 0.8) and SCAI 5 CS (HR 0.20; p=0.04; 95% CI 0.04 - 0.97) at 3 months and SCAI 5 CS at 6 months(HR 0.20; p=0.04; 95% CI 0.46 - 0.9). Conclusion: Our study indicates that invasive hemodynamic evaluation during the treatment of CS favors survival in specially in the SCAI 2, SCAI 3 and SCAI 5 classification groups. In addition, RHC predicts better survival in these patients over 3 and 6 months. We assume that patients in SCAI 4 group may also gain same benefit however, due to limited number of patients our analysis couldn’t reach statistical significance in the SCAI 4 category.

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