Influence of age and shock severity on short-term survival in patients with cardiogenic shock

TY - JOUR

T1 - Influence of age and shock severity on short-term survival in patients with cardiogenic shock

AU - Jentzer, Jacob C

AU - Schrage, Benedikt

AU - Holmes, David R

AU - Dabboura, Salim

AU - Anavekar, Nandan S

AU - Kirchhof, Paulus

AU - Barsness, Gregory W

AU - Blankenberg, Stefan

AU - Bell, Malcolm R

AU - Westermann, Dirk

N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.

PY - 2021/8/24

Y1 - 2021/8/24

N2 - AIMS: Cardiogenic shock (CS) is associated with poor outcomes in older patients, but it remains unclear if this is due to higher shock severity. We sought to determine the associations between age and shock severity on mortality among patients with CS.METHODS AND RESULTS: Patients with a diagnosis of CS from Mayo Clinic (2007-15) and University Clinic Hamburg (2009-17) were subdivided by age. Shock severity was graded using the Society for Cardiovascular Angiography and Intervention (SCAI) shock stages. Predictors of 30-day survival were determined using Cox proportional-hazards analysis. We included 1749 patients (934 from Mayo Clinic and 815 from University Clinic Hamburg), with a mean age of 67.6 ± 14.6 years, including 33.6% females. Acute coronary syndrome was the cause of CS in 54.0%. The distribution of SCAI shock stages was 24.1%; C, 28.0%; D, 33.2%; and E, 14.8%. Older patients had similar overall shock severity, more co-morbidities, worse kidney function, and decreased use of mechanical circulatory support compared to younger patients. Overall 30-day survival was 53.3% and progressively decreased as age or SCAI shock stage increased, with a clear gradient towards lower 30-day survival as a function of increasing age and SCAI shock stage. Progressively older age groups had incrementally lower adjusted 30-day survival than patients aged <50 years.CONCLUSION: Older patients with CS have lower short-term survival, despite similar shock severity, with a high risk of death in older patients with more severe shock. Further research is needed to determine the optimal treatment strategies for older CS patients.

AB - AIMS: Cardiogenic shock (CS) is associated with poor outcomes in older patients, but it remains unclear if this is due to higher shock severity. We sought to determine the associations between age and shock severity on mortality among patients with CS.METHODS AND RESULTS: Patients with a diagnosis of CS from Mayo Clinic (2007-15) and University Clinic Hamburg (2009-17) were subdivided by age. Shock severity was graded using the Society for Cardiovascular Angiography and Intervention (SCAI) shock stages. Predictors of 30-day survival were determined using Cox proportional-hazards analysis. We included 1749 patients (934 from Mayo Clinic and 815 from University Clinic Hamburg), with a mean age of 67.6 ± 14.6 years, including 33.6% females. Acute coronary syndrome was the cause of CS in 54.0%. The distribution of SCAI shock stages was 24.1%; C, 28.0%; D, 33.2%; and E, 14.8%. Older patients had similar overall shock severity, more co-morbidities, worse kidney function, and decreased use of mechanical circulatory support compared to younger patients. Overall 30-day survival was 53.3% and progressively decreased as age or SCAI shock stage increased, with a clear gradient towards lower 30-day survival as a function of increasing age and SCAI shock stage. Progressively older age groups had incrementally lower adjusted 30-day survival than patients aged <50 years.CONCLUSION: Older patients with CS have lower short-term survival, despite similar shock severity, with a high risk of death in older patients with more severe shock. Further research is needed to determine the optimal treatment strategies for older CS patients.

KW - Acute Coronary Syndrome

KW - Aged

KW - Aged, 80 and over

KW - Female

KW - Hospital Mortality

KW - Humans

KW - Male

KW - Middle Aged

KW - Retrospective Studies

KW - Risk Assessment

KW - Shock, Cardiogenic/etiology

U2 - 10.1093/ehjacc/zuaa035

DO - 10.1093/ehjacc/zuaa035

M3 - SCORING: Journal article

C2 - 33580778

VL - 10

SP - 604

EP - 612

JO - EUR HEART J-ACUTE CA

JF - EUR HEART J-ACUTE CA

SN - 2048-8726

IS - 6

ER -