Effect of Admission and Onset Time on the Prognosis of Patients With Cardiogenic Shock

Michael Behnes; Jonas Rusnak; Sascha Egner-Walter; Marinela Ruka; Jonas Dudda; Alexander Schmitt; Jan Forner; Kambis Mashayekhi; Péter Tajti; Mohamed Ayoub; Christel Weiß; Ibrahim Akin; Tobias Schupp

doi:10.1016/j.chest.2023.08.011

Effect of Admission and Onset Time on the Prognosis of Patients With Cardiogenic Shock

Chest. 2023 Aug 12:S0012-3692(23)05270-4. doi: 10.1016/j.chest.2023.08.011. Online ahead of print.

Authors

Affiliations

¹ Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim.
² Department of Internal Medicine and Cardiology, Mediclin Heart Centre Lahr, Lahr.
³ Gottsegen György National Cardiovascular Center, Budapest, Hungary.
⁴ Division of Cardiology and Angiology, Heart Center University of Bochum, Bad Oeynhausen, Germany.
⁵ Institute of Biomathematics and Medical Statistics, Faculty of Medicine Mannheim, University Medical Center, Mannheim.
⁶ Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim. Electronic address: Ibrahim.akin@umm.de.

PMID: 37579943
DOI: 10.1016/j.chest.2023.08.011

Abstract

Background: Related to ongoing demographic changes, the spectrum of patients with cardiogenic shock (CS) has changed significantly, and more patients experience CS in the absence of acute myocardial infarction (AMI). However, these patients typically have been excluded from studies. Very limited data regarding the prognostic role of CS onset and hospital admission are available.

Research question: Do the timing of CS occurrence (CS on admission, ie, primary CS) or CS onset during hospitalization (ie, secondary CS) and the hospital admission time (ie, during hours vs off-hours admission) affect the risk of 30-day all-cause mortality in patients with CS?

Study design and methods: Consecutive patients with CS of any cause from 2019 through 2021 were included at one institution. First, the prognosis of patients with CS on admission was compared with that of patients with CS onset during hospitalization (ie, primary vs secondary CS). Thereafter, prognosis of patients admitted during hours was compared with that of patients admitted off-hours. Statistical analyses included Kaplan-Meier analyses and univariable and multivariable Cox regression analyses.

Results: Two hundred seventy-three patients with CS were included (64% with primary CS). Although secondary CS was not associated with increased risk of all-cause mortality within the entire study cohort (hazard ratio [HR], 1.532; 95% CI, 0.990-2.371; P = .06), increased risk of 30-day all-cause mortality was seen specifically in patients with AMI plus CS and secondary CS (HR, 2.087; 95% CI, 1.126-3.868; P = .02). Furthermore, off-hours admissions were associated with improved risk of all-cause mortality compared with on-hours admissions (HR, 0.497; 95% CI, 0.302-0.817; P = .01), which was observed regardless of AMI plus and CS without AMI.

Interpretation: Primary and secondary CS were associated with a comparable risk of 30-day all-cause mortality in patients with CS; however, off-hours admission was associated independently with improved risk of 30-day all-cause mortality in patients with CS.

Trial registry: ClinicalTrials.gov; No.: NCT05575856; URL: www.

Clinicaltrials: gov.

Keywords: acute myocardial infarction; admission time; cardiogenic shock; mortality; off-hour.

Associated data

ClinicalTrials.gov/NCT05575856