Treatment Intensity for the Management of Cardiogenic Shock: Comparison Between STEMI and Non-STEMI

Shashank S. Sinha; Mohit Pahuja; Rachna Kataria; Vanessa Blumer; Jaime Hernandez-Montfort; Manreet Kanwar; A. Reshad Garan; Yijing Zhang; Jeffrey A. Marbach; Adnan Khalif; Saraschandra Vallabhajosyula; Sandeep Nathan; Jacob Abraham; Borui Li; Katherine L. Thayer; Paulina Baca; Fatou Dieng; Neil M. Harwani; Michael Y. Yin; Anthony J. Faugno; Haroon A. Faraz; Maya Guglin; Gavin W. Hickey; Detlef Wencker; Shelley Hall; Andrew D. Schwartzman; Wissam Khalife; Song Li; Claudius Mahr; Ju H. Kim; Arvind Bhimaraj; Van Khue Ton; Esther Vorovich; Daniel Burkhoff; Navin K. Kapur

doi:10.1016/j.jacadv.2023.100314

Treatment Intensity for the Management of Cardiogenic Shock: Comparison Between STEMI and Non-STEMI

Shashank S. Sinha, Mohit Pahuja, Rachna Kataria, Vanessa Blumer, Jaime Hernandez-Montfort, Manreet Kanwar, A. Reshad Garan, Yijing Zhang, Jeffrey A. Marbach, Adnan Khalif, Saraschandra Vallabhajosyula, Sandeep Nathan, Jacob Abraham, Borui Li, Katherine L. Thayer, Paulina Baca, Fatou Dieng, Neil M. Harwani, Michael Y. Yin, Anthony J. FaugnoHaroon A. Faraz, Maya Guglin, Gavin W. Hickey, Detlef Wencker, Shelley Hall, Andrew D. Schwartzman, Wissam Khalife, Song Li, Claudius Mahr, Ju H. Kim, Arvind Bhimaraj, Van Khue Ton, Esther Vorovich, Daniel Burkhoff, Navin K. Kapur^*

^*Corresponding author for this work

Medicine, Cardiology Division

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

9 Scopus citations

Abstract

Background: Cardiogenic shock is a leading cause of mortality in patients with acute myocardial infarction. Objectives: The authors sought to compare clinical characteristics, hospital trajectory, and drug and device use between patients with ST-segment elevation myocardial infarction-related cardiogenic shock (STEMI-CS) and those without (non-ST-segment elevation myocardial infarction complicated by cardiogenic shock [NSTEMI-CS]). Methods: We analyzed data from 1,110 adult admissions with cardiogenic shock complicating acute myocardial infarction (AMI-CS) across 17 centers within Cardiogenic Shock Working Group. The primary end point was in-hospital mortality. Results: Our study included 1,110 patients with AMI-CS, of which 731 (65.8%) had STEMI-CS and 379 (34.2%) had NSTEMI-CS. Most patients were male (STEMI-CS: 71.6%, NSTEMI-CS: 66.5%) and White (STEMI-CS: 53.8%, NSTEMI-CS: 64.1%). In-hospital mortality was 41% and was similar among patients with STEMI-CS and NSTEMI-CS (43% vs 39%, P = 0.23). Patients with out-of-hospital cardiac arrest had higher in-hospital mortality in patients with NSTEMI-CS (63% vs 36%, P = 0.006) as compared to patients with STEMI-CS (52% vs 41%, P = 0.16). Similar results were observed for in-hospital cardiac arrest in patients with STEMI-CS (63% vs 33%, P < 0.001) and NSTEMI-CS (60% vs 32%, P < 0.001). Only 27% of patients with STEMI-CS and 12% of NSTEMI-CS received both a drug and temporary mechanical circulatory support device during the first 24 hours, which increased to 78% and 61%, respectively, throughout the course of the hospitalization (P < 0.001 for both). Conclusions: Despite increasing use of inotropic and vasoactive support and mechanical circulatory support throughout the hospitalization, both patients with STEMI-CS and NSTEMI-CS remain at increased risk for in-hospital mortality. Randomized controls trials are needed to elucidate whether timing and sequence of escalation of support improves outcomes in patients with AMI-CS.

Original language	English (US)
Article number	100314
Journal	JACC: Advances
Volume	2
Issue number	3
DOIs	https://doi.org/10.1016/j.jacadv.2023.100314
State	Published - May 2023

Funding

This work was supported by a NIH RO1 grants to Dr Kapur (R01HL139785-01; R01HL159089-01) and institutional grants from Abiomed Inc, Boston Scientific Inc, Abbott Laboratories, Getinge Inc, and LivaNova Inc to Tufts Medical Center. Sponsors had no input on collection, analysis, and interpretation of the data, nor in the preparation, review, or approval of the manuscript. Dr Kapur has received consulting honoraria and institutional grant support from Abbott Laboratories, Abiomed Inc, Boston Scientific, Medtronic, LivaNova, Getinge, and Zoll. Dr Hernandez-Montfort is a consultant for Abiomed Inc. Dr Abraham is a consultant for Abbott Laboratories and Abiomed Inc. Dr Burkhoff has received support from consulting services provided from Abiomed Inc. to Cardiovascular Research Foundation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Keywords

acute myocardial infarction
cardiogenic shock
heart failure

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Dentistry (miscellaneous)

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10.1016/j.jacadv.2023.100314

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Sinha, S. S., Pahuja, M., Kataria, R., Blumer, V., Hernandez-Montfort, J., Kanwar, M., Garan, A. R., Zhang, Y., Marbach, J. A., Khalif, A., Vallabhajosyula, S., Nathan, S., Abraham, J., Li, B., Thayer, K. L., Baca, P., Dieng, F., Harwani, N. M., Yin, M. Y., ... Kapur, N. K. (2023). Treatment Intensity for the Management of Cardiogenic Shock: Comparison Between STEMI and Non-STEMI. JACC: Advances, 2(3), Article 100314. https://doi.org/10.1016/j.jacadv.2023.100314

@article{9dd090eb738b4702b2de552c08e69a92,

title = "Treatment Intensity for the Management of Cardiogenic Shock: Comparison Between STEMI and Non-STEMI",

abstract = "Background: Cardiogenic shock is a leading cause of mortality in patients with acute myocardial infarction. Objectives: The authors sought to compare clinical characteristics, hospital trajectory, and drug and device use between patients with ST-segment elevation myocardial infarction-related cardiogenic shock (STEMI-CS) and those without (non-ST-segment elevation myocardial infarction complicated by cardiogenic shock [NSTEMI-CS]). Methods: We analyzed data from 1,110 adult admissions with cardiogenic shock complicating acute myocardial infarction (AMI-CS) across 17 centers within Cardiogenic Shock Working Group. The primary end point was in-hospital mortality. Results: Our study included 1,110 patients with AMI-CS, of which 731 (65.8%) had STEMI-CS and 379 (34.2%) had NSTEMI-CS. Most patients were male (STEMI-CS: 71.6%, NSTEMI-CS: 66.5%) and White (STEMI-CS: 53.8%, NSTEMI-CS: 64.1%). In-hospital mortality was 41% and was similar among patients with STEMI-CS and NSTEMI-CS (43% vs 39%, P = 0.23). Patients with out-of-hospital cardiac arrest had higher in-hospital mortality in patients with NSTEMI-CS (63% vs 36%, P = 0.006) as compared to patients with STEMI-CS (52% vs 41%, P = 0.16). Similar results were observed for in-hospital cardiac arrest in patients with STEMI-CS (63% vs 33%, P < 0.001) and NSTEMI-CS (60% vs 32%, P < 0.001). Only 27% of patients with STEMI-CS and 12% of NSTEMI-CS received both a drug and temporary mechanical circulatory support device during the first 24 hours, which increased to 78% and 61%, respectively, throughout the course of the hospitalization (P < 0.001 for both). Conclusions: Despite increasing use of inotropic and vasoactive support and mechanical circulatory support throughout the hospitalization, both patients with STEMI-CS and NSTEMI-CS remain at increased risk for in-hospital mortality. Randomized controls trials are needed to elucidate whether timing and sequence of escalation of support improves outcomes in patients with AMI-CS.",

keywords = "acute myocardial infarction, cardiogenic shock, heart failure",

author = "Sinha, {Shashank S.} and Mohit Pahuja and Rachna Kataria and Vanessa Blumer and Jaime Hernandez-Montfort and Manreet Kanwar and Garan, {A. Reshad} and Yijing Zhang and Marbach, {Jeffrey A.} and Adnan Khalif and Saraschandra Vallabhajosyula and Sandeep Nathan and Jacob Abraham and Borui Li and Thayer, {Katherine L.} and Paulina Baca and Fatou Dieng and Harwani, {Neil M.} and Yin, {Michael Y.} and Faugno, {Anthony J.} and Faraz, {Haroon A.} and Maya Guglin and Hickey, {Gavin W.} and Detlef Wencker and Shelley Hall and Schwartzman, {Andrew D.} and Wissam Khalife and Song Li and Claudius Mahr and Kim, {Ju H.} and Arvind Bhimaraj and Ton, {Van Khue} and Esther Vorovich and Daniel Burkhoff and Kapur, {Navin K.}",

note = "Publisher Copyright: {\textcopyright} 2023 The Authors",

year = "2023",

month = may,

doi = "10.1016/j.jacadv.2023.100314",

language = "English (US)",

volume = "2",

journal = "JACC: Advances",

issn = "2772-963X",

publisher = "Elsevier B.V.",

number = "3",

}

Sinha, SS, Pahuja, M, Kataria, R, Blumer, V, Hernandez-Montfort, J, Kanwar, M, Garan, AR, Zhang, Y, Marbach, JA, Khalif, A, Vallabhajosyula, S, Nathan, S, Abraham, J, Li, B, Thayer, KL, Baca, P, Dieng, F, Harwani, NM, Yin, MY, Faugno, AJ, Faraz, HA, Guglin, M, Hickey, GW, Wencker, D, Hall, S, Schwartzman, AD, Khalife, W, Li, S, Mahr, C, Kim, JH, Bhimaraj, A, Ton, VK, Vorovich, E, Burkhoff, D & Kapur, NK 2023, 'Treatment Intensity for the Management of Cardiogenic Shock: Comparison Between STEMI and Non-STEMI', JACC: Advances, vol. 2, no. 3, 100314. https://doi.org/10.1016/j.jacadv.2023.100314

TY - JOUR

T1 - Treatment Intensity for the Management of Cardiogenic Shock

T2 - Comparison Between STEMI and Non-STEMI

AU - Sinha, Shashank S.

AU - Pahuja, Mohit

AU - Kataria, Rachna

AU - Blumer, Vanessa

AU - Hernandez-Montfort, Jaime

AU - Kanwar, Manreet

AU - Garan, A. Reshad

AU - Zhang, Yijing

AU - Marbach, Jeffrey A.

AU - Khalif, Adnan

AU - Vallabhajosyula, Saraschandra

AU - Nathan, Sandeep

AU - Abraham, Jacob

AU - Li, Borui

AU - Thayer, Katherine L.

AU - Baca, Paulina

AU - Dieng, Fatou

AU - Harwani, Neil M.

AU - Yin, Michael Y.

AU - Faugno, Anthony J.

AU - Faraz, Haroon A.

AU - Guglin, Maya

AU - Hickey, Gavin W.

AU - Wencker, Detlef

AU - Hall, Shelley

AU - Schwartzman, Andrew D.

AU - Khalife, Wissam

AU - Li, Song

AU - Mahr, Claudius

AU - Kim, Ju H.

AU - Bhimaraj, Arvind

AU - Ton, Van Khue

AU - Vorovich, Esther

AU - Burkhoff, Daniel

AU - Kapur, Navin K.

PY - 2023/5

Y1 - 2023/5

N2 - Background: Cardiogenic shock is a leading cause of mortality in patients with acute myocardial infarction. Objectives: The authors sought to compare clinical characteristics, hospital trajectory, and drug and device use between patients with ST-segment elevation myocardial infarction-related cardiogenic shock (STEMI-CS) and those without (non-ST-segment elevation myocardial infarction complicated by cardiogenic shock [NSTEMI-CS]). Methods: We analyzed data from 1,110 adult admissions with cardiogenic shock complicating acute myocardial infarction (AMI-CS) across 17 centers within Cardiogenic Shock Working Group. The primary end point was in-hospital mortality. Results: Our study included 1,110 patients with AMI-CS, of which 731 (65.8%) had STEMI-CS and 379 (34.2%) had NSTEMI-CS. Most patients were male (STEMI-CS: 71.6%, NSTEMI-CS: 66.5%) and White (STEMI-CS: 53.8%, NSTEMI-CS: 64.1%). In-hospital mortality was 41% and was similar among patients with STEMI-CS and NSTEMI-CS (43% vs 39%, P = 0.23). Patients with out-of-hospital cardiac arrest had higher in-hospital mortality in patients with NSTEMI-CS (63% vs 36%, P = 0.006) as compared to patients with STEMI-CS (52% vs 41%, P = 0.16). Similar results were observed for in-hospital cardiac arrest in patients with STEMI-CS (63% vs 33%, P < 0.001) and NSTEMI-CS (60% vs 32%, P < 0.001). Only 27% of patients with STEMI-CS and 12% of NSTEMI-CS received both a drug and temporary mechanical circulatory support device during the first 24 hours, which increased to 78% and 61%, respectively, throughout the course of the hospitalization (P < 0.001 for both). Conclusions: Despite increasing use of inotropic and vasoactive support and mechanical circulatory support throughout the hospitalization, both patients with STEMI-CS and NSTEMI-CS remain at increased risk for in-hospital mortality. Randomized controls trials are needed to elucidate whether timing and sequence of escalation of support improves outcomes in patients with AMI-CS.

AB - Background: Cardiogenic shock is a leading cause of mortality in patients with acute myocardial infarction. Objectives: The authors sought to compare clinical characteristics, hospital trajectory, and drug and device use between patients with ST-segment elevation myocardial infarction-related cardiogenic shock (STEMI-CS) and those without (non-ST-segment elevation myocardial infarction complicated by cardiogenic shock [NSTEMI-CS]). Methods: We analyzed data from 1,110 adult admissions with cardiogenic shock complicating acute myocardial infarction (AMI-CS) across 17 centers within Cardiogenic Shock Working Group. The primary end point was in-hospital mortality. Results: Our study included 1,110 patients with AMI-CS, of which 731 (65.8%) had STEMI-CS and 379 (34.2%) had NSTEMI-CS. Most patients were male (STEMI-CS: 71.6%, NSTEMI-CS: 66.5%) and White (STEMI-CS: 53.8%, NSTEMI-CS: 64.1%). In-hospital mortality was 41% and was similar among patients with STEMI-CS and NSTEMI-CS (43% vs 39%, P = 0.23). Patients with out-of-hospital cardiac arrest had higher in-hospital mortality in patients with NSTEMI-CS (63% vs 36%, P = 0.006) as compared to patients with STEMI-CS (52% vs 41%, P = 0.16). Similar results were observed for in-hospital cardiac arrest in patients with STEMI-CS (63% vs 33%, P < 0.001) and NSTEMI-CS (60% vs 32%, P < 0.001). Only 27% of patients with STEMI-CS and 12% of NSTEMI-CS received both a drug and temporary mechanical circulatory support device during the first 24 hours, which increased to 78% and 61%, respectively, throughout the course of the hospitalization (P < 0.001 for both). Conclusions: Despite increasing use of inotropic and vasoactive support and mechanical circulatory support throughout the hospitalization, both patients with STEMI-CS and NSTEMI-CS remain at increased risk for in-hospital mortality. Randomized controls trials are needed to elucidate whether timing and sequence of escalation of support improves outcomes in patients with AMI-CS.

KW - acute myocardial infarction

KW - cardiogenic shock

KW - heart failure

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DO - 10.1016/j.jacadv.2023.100314

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AN - SCOPUS:85180251405

SN - 2772-963X

VL - 2

JO - JACC: Advances

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IS - 3

M1 - 100314

ER -

Treatment Intensity for the Management of Cardiogenic Shock: Comparison Between STEMI and Non-STEMI

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