Factors associated with acute limb ischemia in cardiogenic shock and downstream clinical outcomes: Insights from the Cardiogenic Shock Working Group

Ajar Kochar; Saraschandra Vallabhajosyula; Kevin John; Shashank S. Sinha; Michele Esposito; Mohit Pahuja; Colin Hirst; Song Li; Qiuyue Kong; Borui Li; Peter Natov; Manreet Kanwar; Jaime Hernandez-Montfort; A. Reshad Garan; Karol Walec; Peter Zazzali; Paavni Sangal; Van Khue Ton; Elric Zweck; Rachna Kataria; Maya Guglin; Esther Vorovich; Sandeep Nathan; Jacob Abraham; Neil M. Harwani; Justin A. Fried; Maryjane Farr; Shelley A. Hall; Gavin W. Hickey; Detlef Wencker; Andrew D. Schwartzman; Wissam Khalife; Claudius Mahr; Ju H. Kim; Arvind Bhimaraj; Vanessa Blumer; Anthony Faugno; Daniel Burkhoff; Navin K. Kapur

doi:10.1016/j.healun.2024.06.012

Factors associated with acute limb ischemia in cardiogenic shock and downstream clinical outcomes: Insights from the Cardiogenic Shock Working Group

Ajar Kochar, Saraschandra Vallabhajosyula, Kevin John, Shashank S. Sinha, Michele Esposito, Mohit Pahuja, Colin Hirst, Song Li, Qiuyue Kong, Borui Li, Peter Natov, Manreet Kanwar, Jaime Hernandez-Montfort, A. Reshad Garan, Karol Walec, Peter Zazzali, Paavni Sangal, Van Khue Ton, Elric Zweck, Rachna KatariaMaya Guglin, Esther Vorovich, Sandeep Nathan, Jacob Abraham, Neil M. Harwani, Justin A. Fried, Maryjane Farr, Shelley A. Hall, Gavin W. Hickey, Detlef Wencker, Andrew D. Schwartzman, Wissam Khalife, Claudius Mahr, Ju H. Kim, Arvind Bhimaraj, Vanessa Blumer, Anthony Faugno, Daniel Burkhoff, Navin K. Kapur^*

^*Corresponding author for this work

Medicine, Cardiology Division

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

Abstract

Background: There are limited data depicting the prevalence and ramifications of acute limb ischemia (ALI) among cardiogenic shock (CS) patients. Methods: We employed data from the Cardiogenic Shock Working Group (CSWG), a consortium including 33 sites. We constructed a multi-variable logistic regression to examine the association between clinical factors and ALI, we generated another logistic regression model to ascertain the association of ALI with mortality. Results: There were 7,070 patients with CS and 399 (5.6%) developed ALI. Patients with ALI were more likely to be female (40.4% vs 29.4%) and have peripheral arterial disease (13.8% vs 8.3%). Stratified by maximum society for cardiovascular angiography & intervention (SCAI) shock stage, the rates of ALI were stage B 0.0%, stage C 1.8%, stage D 4.1%, and stage E 10.3%. Factors associated with higher risk for ALI included: peripheral vascular disease OR 2.24 (95% CI: 1.53–3.23; p < 0.01) and ≥2 mechanical circulatory support (MCS) devices OR 1.66 (95% CI: 1.24–2.21, p < 0.01). ALI was highest for venous-arterial extracorporeal membrane oxygenation (VA-ECMO) patients (11.6%) or VA-ECMO + intra-aortic balloon pump (IABP)/Impella CP (16.6%) yet use of distal perfusion catheters was less than 50%. Mortality was 38.0% for CS patients without ALI but 57.4% for CS patients with ALI. ALI was significantly associated with mortality, adjusted OR 1.40 (95% CI 1.01–1.95, p < 0.01). Conclusions: The rate of ALI was 6% among CS patients. Factors most associated with ALI include peripheral vascular disease and multiple MCS devices. The downstream ramifications of ALI were dire with a considerably higher risk of mortality.

Original language	English (US)
Pages (from-to)	1846-1856
Number of pages	11
Journal	Journal of Heart and Lung Transplantation
Volume	43
Issue number	11
DOIs	https://doi.org/10.1016/j.healun.2024.06.012
State	Published - Nov 2024

Funding

This work was supported by institutional grants from Abiomed Inc, Boston Scientific Inc, Abbott Laboratories, Getinge Inc, and LivaNova Inc to Tufts Medical Center. The sponsors had no input on collection, analysis, and interpretation of the data, nor in the preparation, review, or approval of the manuscript. Dr. Kochar has received institutional grant support from Shockwave Inc, Rampart Inc and consulting honoraria for Faraday Pharmaceuticals. Dr Kapur has received consulting honoraria and institutional grant support from Abbott Laboratories, Abiomed Inc, Boston Scientific, Medtronic, LivaNova, Getinge, and Zoll. Dr Kanwar has served on the advisory board for Abiomed Inc., Abbott Laboratories and CorWave. Dr Sinha has served as a consultant for Abiomed Inc. Dr Garan has served as a consultant for NuPulseCV, has been on the scientific advisory board for Abiomed, and is a recipient of research support from Verantos and Abbott. Dr Hernandez-Montfort has served as a consultant for Abiomed Inc. Dr Abraham has served as a consultant for Abbott Laboratories and Abiomed Inc. Dr Nathan has received consulting honoraria from Abiomed, Getinge, and CSI. Dr Hall has served as a consultant to Abiomed, Abbott, and Medtronic. Dr Mahr has served as a consultant to Abbott, Abiomed, and Syncaria. Dr Burkhoff has received an unrestricted, educational grant from Abiomed Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Keywords

acute limb ischemia
cardiogenic shock
ECMO
heart failure
mechanical circulatory support
mortality

ASJC Scopus subject areas

Surgery
Pulmonary and Respiratory Medicine
Cardiology and Cardiovascular Medicine
Transplantation

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.healun.2024.06.012

Cite this

Kochar, A., Vallabhajosyula, S., John, K., Sinha, S. S., Esposito, M., Pahuja, M., Hirst, C., Li, S., Kong, Q., Li, B., Natov, P., Kanwar, M., Hernandez-Montfort, J., Garan, A. R., Walec, K., Zazzali, P., Sangal, P., Ton, V. K., Zweck, E., ... Kapur, N. K. (2024). Factors associated with acute limb ischemia in cardiogenic shock and downstream clinical outcomes: Insights from the Cardiogenic Shock Working Group. Journal of Heart and Lung Transplantation, 43(11), 1846-1856. https://doi.org/10.1016/j.healun.2024.06.012

@article{ef47b484f3a44163a9e40cbe82264a9f,

title = "Factors associated with acute limb ischemia in cardiogenic shock and downstream clinical outcomes: Insights from the Cardiogenic Shock Working Group",

abstract = "Background: There are limited data depicting the prevalence and ramifications of acute limb ischemia (ALI) among cardiogenic shock (CS) patients. Methods: We employed data from the Cardiogenic Shock Working Group (CSWG), a consortium including 33 sites. We constructed a multi-variable logistic regression to examine the association between clinical factors and ALI, we generated another logistic regression model to ascertain the association of ALI with mortality. Results: There were 7,070 patients with CS and 399 (5.6%) developed ALI. Patients with ALI were more likely to be female (40.4% vs 29.4%) and have peripheral arterial disease (13.8% vs 8.3%). Stratified by maximum society for cardiovascular angiography & intervention (SCAI) shock stage, the rates of ALI were stage B 0.0%, stage C 1.8%, stage D 4.1%, and stage E 10.3%. Factors associated with higher risk for ALI included: peripheral vascular disease OR 2.24 (95% CI: 1.53–3.23; p < 0.01) and ≥2 mechanical circulatory support (MCS) devices OR 1.66 (95% CI: 1.24–2.21, p < 0.01). ALI was highest for venous-arterial extracorporeal membrane oxygenation (VA-ECMO) patients (11.6%) or VA-ECMO + intra-aortic balloon pump (IABP)/Impella CP (16.6%) yet use of distal perfusion catheters was less than 50%. Mortality was 38.0% for CS patients without ALI but 57.4% for CS patients with ALI. ALI was significantly associated with mortality, adjusted OR 1.40 (95% CI 1.01–1.95, p < 0.01). Conclusions: The rate of ALI was 6% among CS patients. Factors most associated with ALI include peripheral vascular disease and multiple MCS devices. The downstream ramifications of ALI were dire with a considerably higher risk of mortality.",

keywords = "acute limb ischemia, cardiogenic shock, ECMO, heart failure, mechanical circulatory support, mortality",

author = "Ajar Kochar and Saraschandra Vallabhajosyula and Kevin John and Sinha, {Shashank S.} and Michele Esposito and Mohit Pahuja and Colin Hirst and Song Li and Qiuyue Kong and Borui Li and Peter Natov and Manreet Kanwar and Jaime Hernandez-Montfort and Garan, {A. Reshad} and Karol Walec and Peter Zazzali and Paavni Sangal and Ton, {Van Khue} and Elric Zweck and Rachna Kataria and Maya Guglin and Esther Vorovich and Sandeep Nathan and Jacob Abraham and Harwani, {Neil M.} and Fried, {Justin A.} and Maryjane Farr and Hall, {Shelley A.} and Hickey, {Gavin W.} and Detlef Wencker and Schwartzman, {Andrew D.} and Wissam Khalife and Claudius Mahr and Kim, {Ju H.} and Arvind Bhimaraj and Vanessa Blumer and Anthony Faugno and Daniel Burkhoff and Kapur, {Navin K.}",

note = "Publisher Copyright: {\textcopyright} 2024 International Society for the Heart and Lung Transplantation",

year = "2024",

month = nov,

doi = "10.1016/j.healun.2024.06.012",

language = "English (US)",

volume = "43",

pages = "1846--1856",

journal = "Journal of Heart and Lung Transplantation",

issn = "1053-2498",

publisher = "Elsevier Inc.",

number = "11",

}

Kochar, A, Vallabhajosyula, S, John, K, Sinha, SS, Esposito, M, Pahuja, M, Hirst, C, Li, S, Kong, Q, Li, B, Natov, P, Kanwar, M, Hernandez-Montfort, J, Garan, AR, Walec, K, Zazzali, P, Sangal, P, Ton, VK, Zweck, E, Kataria, R, Guglin, M, Vorovich, E, Nathan, S, Abraham, J, Harwani, NM, Fried, JA, Farr, M, Hall, SA, Hickey, GW, Wencker, D, Schwartzman, AD, Khalife, W, Mahr, C, Kim, JH, Bhimaraj, A, Blumer, V, Faugno, A, Burkhoff, D & Kapur, NK 2024, 'Factors associated with acute limb ischemia in cardiogenic shock and downstream clinical outcomes: Insights from the Cardiogenic Shock Working Group', Journal of Heart and Lung Transplantation, vol. 43, no. 11, pp. 1846-1856. https://doi.org/10.1016/j.healun.2024.06.012

Factors associated with acute limb ischemia in cardiogenic shock and downstream clinical outcomes: Insights from the Cardiogenic Shock Working Group. / Kochar, Ajar; Vallabhajosyula, Saraschandra; John, Kevin et al.
In: Journal of Heart and Lung Transplantation, Vol. 43, No. 11, 11.2024, p. 1846-1856.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Factors associated with acute limb ischemia in cardiogenic shock and downstream clinical outcomes

T2 - Insights from the Cardiogenic Shock Working Group

AU - Kochar, Ajar

AU - Vallabhajosyula, Saraschandra

AU - John, Kevin

AU - Sinha, Shashank S.

AU - Esposito, Michele

AU - Pahuja, Mohit

AU - Hirst, Colin

AU - Li, Song

AU - Kong, Qiuyue

AU - Li, Borui

AU - Natov, Peter

AU - Kanwar, Manreet

AU - Hernandez-Montfort, Jaime

AU - Garan, A. Reshad

AU - Walec, Karol

AU - Zazzali, Peter

AU - Sangal, Paavni

AU - Ton, Van Khue

AU - Zweck, Elric

AU - Kataria, Rachna

AU - Guglin, Maya

AU - Vorovich, Esther

AU - Nathan, Sandeep

AU - Abraham, Jacob

AU - Harwani, Neil M.

AU - Fried, Justin A.

AU - Farr, Maryjane

AU - Hall, Shelley A.

AU - Hickey, Gavin W.

AU - Wencker, Detlef

AU - Schwartzman, Andrew D.

AU - Khalife, Wissam

AU - Mahr, Claudius

AU - Kim, Ju H.

AU - Bhimaraj, Arvind

AU - Blumer, Vanessa

AU - Faugno, Anthony

AU - Burkhoff, Daniel

AU - Kapur, Navin K.

PY - 2024/11

Y1 - 2024/11

N2 - Background: There are limited data depicting the prevalence and ramifications of acute limb ischemia (ALI) among cardiogenic shock (CS) patients. Methods: We employed data from the Cardiogenic Shock Working Group (CSWG), a consortium including 33 sites. We constructed a multi-variable logistic regression to examine the association between clinical factors and ALI, we generated another logistic regression model to ascertain the association of ALI with mortality. Results: There were 7,070 patients with CS and 399 (5.6%) developed ALI. Patients with ALI were more likely to be female (40.4% vs 29.4%) and have peripheral arterial disease (13.8% vs 8.3%). Stratified by maximum society for cardiovascular angiography & intervention (SCAI) shock stage, the rates of ALI were stage B 0.0%, stage C 1.8%, stage D 4.1%, and stage E 10.3%. Factors associated with higher risk for ALI included: peripheral vascular disease OR 2.24 (95% CI: 1.53–3.23; p < 0.01) and ≥2 mechanical circulatory support (MCS) devices OR 1.66 (95% CI: 1.24–2.21, p < 0.01). ALI was highest for venous-arterial extracorporeal membrane oxygenation (VA-ECMO) patients (11.6%) or VA-ECMO + intra-aortic balloon pump (IABP)/Impella CP (16.6%) yet use of distal perfusion catheters was less than 50%. Mortality was 38.0% for CS patients without ALI but 57.4% for CS patients with ALI. ALI was significantly associated with mortality, adjusted OR 1.40 (95% CI 1.01–1.95, p < 0.01). Conclusions: The rate of ALI was 6% among CS patients. Factors most associated with ALI include peripheral vascular disease and multiple MCS devices. The downstream ramifications of ALI were dire with a considerably higher risk of mortality.

AB - Background: There are limited data depicting the prevalence and ramifications of acute limb ischemia (ALI) among cardiogenic shock (CS) patients. Methods: We employed data from the Cardiogenic Shock Working Group (CSWG), a consortium including 33 sites. We constructed a multi-variable logistic regression to examine the association between clinical factors and ALI, we generated another logistic regression model to ascertain the association of ALI with mortality. Results: There were 7,070 patients with CS and 399 (5.6%) developed ALI. Patients with ALI were more likely to be female (40.4% vs 29.4%) and have peripheral arterial disease (13.8% vs 8.3%). Stratified by maximum society for cardiovascular angiography & intervention (SCAI) shock stage, the rates of ALI were stage B 0.0%, stage C 1.8%, stage D 4.1%, and stage E 10.3%. Factors associated with higher risk for ALI included: peripheral vascular disease OR 2.24 (95% CI: 1.53–3.23; p < 0.01) and ≥2 mechanical circulatory support (MCS) devices OR 1.66 (95% CI: 1.24–2.21, p < 0.01). ALI was highest for venous-arterial extracorporeal membrane oxygenation (VA-ECMO) patients (11.6%) or VA-ECMO + intra-aortic balloon pump (IABP)/Impella CP (16.6%) yet use of distal perfusion catheters was less than 50%. Mortality was 38.0% for CS patients without ALI but 57.4% for CS patients with ALI. ALI was significantly associated with mortality, adjusted OR 1.40 (95% CI 1.01–1.95, p < 0.01). Conclusions: The rate of ALI was 6% among CS patients. Factors most associated with ALI include peripheral vascular disease and multiple MCS devices. The downstream ramifications of ALI were dire with a considerably higher risk of mortality.

KW - acute limb ischemia

KW - cardiogenic shock

KW - ECMO

KW - heart failure

KW - mechanical circulatory support

KW - mortality

UR - http://www.scopus.com/inward/record.url?scp=85203259101&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85203259101&partnerID=8YFLogxK

U2 - 10.1016/j.healun.2024.06.012

DO - 10.1016/j.healun.2024.06.012

M3 - Article

C2 - 38944132

AN - SCOPUS:85203259101

SN - 1053-2498

VL - 43

SP - 1846

EP - 1856

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

IS - 11

ER -

Factors associated with acute limb ischemia in cardiogenic shock and downstream clinical outcomes: Insights from the Cardiogenic Shock Working Group

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this