SPC365

Cardiogenic Shock in Patients Severe Left Ventricular Dysfunction owing to Acute Myocardial Infarction

Session: Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker: Rita Rocha

Congress: CPC 2021
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 14. Acute Cardiac Care
Subtheme: 14.4 Acute Cardiac Care – Cardiogenic Shock
Session Type: Posters
FP Number: ---
Authors: Rita Caldeira Da Rocha; Bruno Piçarra; Miguel Carias; Francisco Cláudio; João Pais; Renato Fernandes; Manuel Trinca

<p style="text-align:justify"><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="color:#212121">Introduction: Left ventricular function is assumed to be the main predictor of cardiogenic shock (CS), however trials and registries show that in average left ventricular function is only moderately depressed in CS after acute myocardial infarction.&nbsp; </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="color:#212121">Purpose: Characterize population of patients (Pts) with CS after acute myocardial infarction(AMI)and with severe left ventricular dysfunction (defined as ejection fraction (EF) &lt;30%).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#212121">Methods:From a national multicenter registry,we evaluated 729ptswith CS after AMI.We considered 2 groups: Group 1&ndash;Pts with CS and EF&lt; 30% and Group 2- Pts with CS and EF &gt;30%.We registered age,gender,cardiovascular and non-cardiovascular comorbidities,electrocardiographic presentation,vital signs at admission,reperfusion strategy and coronary anatomy. We also evaluated in-hospital complications,such as re-infarction,mechanical complications,high-grade atrial ventricular block,sustained ventricular tachycardia(VT),atrial fibrillation(AF) and stroke.We compared in-hospital mortality and multivariate analysis was performed to assess the impact of EF in in-hospital mortality and to identify predictors of severe left ventricular function.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results:Severe dysfunction in Cardiogenic shock due to AMI was present in 28,9%(n=211)of pts(68% male,mean age of 72&plusmn;12years old).Group 1had higher incidence of previous heart disease,such as AMI,previous PCI and congestive heart failure(27%vs14%,p&lt;0.001;17,7%vs9,6%p=0.002 and 16%vs10%,p=0.022,respectively).STEMIpts were 71%(n=149),and timing from symptoms until first contact was longer(185min(90;437)vs123(60;300),p&lt;0.001).Undetermined location AMI was more often in group 1(8%vs2%,p&lt;0.001),particularly due to left or right bundle brunch block(13%vs4,7%,p&lt;0.001,and 15%vs10%,p=0.041 respectively).Anterior STEMI was also more prevalent in this groups(81%vs46%,p&lt;0.001).<span style="background-color:white"><span style="color:#212121">No differences were observed on coronariography rate, rate or type of reperfusion nor multivessel disease.</span></span>Group 1pts presented more with left main(LM)(25%vs12%,p&lt;0.001)and anterior descending(AD)(9,4%vs2,4%,p&lt;0.001)arteries lesions (88%vs72,4%,p&lt;0.001)or occlusion(65,5%vs33,7%,p&lt;0.001).Group 1presented more with in-hospital VT(16%v10,8%,p=0.048).In-hospital mortality was also higher(56,5%vs29,5%,p&lt;0.001).After multivariate analysis we found that severe left ventricular dysfunction was a mortality predictor(OR 3.37;IC95%[2,05-5,54],p&lt;0.001).LM(OR 3,41;95%CI 1,86-6,26,p&lt;0.001)and AD(OR2,74;95%CI 1,51-4,96,p=0.001)arteries disease and previous AMI (OR2,36; 95%CI 1,28-4,37,p=0.006)were predictors of severe LV dysfunction.</span></span></p>

<pre style="text-align:justify">
<span style="font-size:10pt"><span style="background-color:white"><span style="font-family:&quot;Courier New&quot;"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Conclusions</span></span></span><span style="color:black">:</span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">S</span></span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#212121">everely</span></span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#212121"> depressed EF is a predictor of in-hospital mortality. Left main and anterior descending artery disease and previous AMI were identified as predictors of an EF&lt;30%.</span></span></span></span></span></span></pre>