Anne Freund1, Alexander Jobs2, Philipp Lurz3, Hans-Josef Feistritzer3, Suzanne de Waha-Thiele4, Roza Meyer-Saraei4, Gilles Montalescot5, Kurt Huber6, Marko Noc7, Stephan Windecker8, Uwe Zeymer9, Taoufik Ouarrak10, Steffen Schneider10, Holger Thiele11, Steffen Desch2. 1. Heart Center Leipzig at the University of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany; German Center for Cardiovascular Research, partner site Hamburg/Kiel/Lübeck, Lübeck, Germany; Leipzig Heart Institute, Leipzig, Germany. Electronic address: anne.freund@medizin.uni-leipzig.de. 2. Heart Center Leipzig at the University of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany; German Center for Cardiovascular Research, partner site Hamburg/Kiel/Lübeck, Lübeck, Germany; Department of Cardiology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany. 3. Heart Center Leipzig at the University of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany. 4. German Center for Cardiovascular Research, partner site Hamburg/Kiel/Lübeck, Lübeck, Germany; Department of Cardiology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany. 5. ACTION Study Group, Centre Hospitalier Universitaire Pitié-Salpêtrière, Sorbonne Université, Paris, France. 6. Department of Cardiology, Wilhelminenspital, Sigmund Freud University Medical School, Vienna, Austria. 7. Center of Intensive Internal Medicine, University Medical Center Ljubljana, Ljubljana, Slovenia. 8. Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland. 9. Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany; Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany. 10. Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany. 11. Heart Center Leipzig at the University of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany.
Abstract
OBJECTIVES: This study sought to determine frequency, associated factors, and impact of bleeding in infarct-related cardiogenic shock. BACKGROUND: Early revascularization is associated with improved survival in patients with acute myocardial infarction complicated by cardiogenic shock. On the downside, invasive treatment and accompanying antithrombotic therapies are associated with an increased bleeding risk. Prospective data assessing the incidence, severity, risk factors, and prognostic implication of bleeding in patients with cardiogenic shock are scarce. METHODS: As a pre-defined subanalysis of the CULPRIT-SHOCK (PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock) randomized trial, we examined distribution of bleeding events in 684 patients with infarct-related cardiogenic shock and compared patients with any bleeding to those without. RESULTS: A total of 21.5% patients experienced at least 1 bleeding event until 30 days after randomization. The vast majority of bleeding (57%) occurred within the first 2 days of hospitalization. Patients with bleeding had prolonged catecholamine treatment and mechanical ventilation and there was a significant association with sepsis, peripheral ischemic complications, new atrial fibrillation, and ventricular fibrillation. In multivariable analysis, bleeding was associated with a significantly higher mortality (hazard ratio: 2.11; 95% confidence interval: 1.63 to 2.75; p < 0.0001). Treatment with active mechanical support by extracorporeal membrane oxygenation or Impella emerged as the major risk factor for bleeding. CONCLUSIONS: Risk of bleeding in infarct-related cardiogenic shock is high and associated with increased mortality.
RCT Entities:
OBJECTIVES: This study sought to determine frequency, associated factors, and impact of bleeding in infarct-related cardiogenic shock. BACKGROUND: Early revascularization is associated with improved survival in patients with acute myocardial infarction complicated by cardiogenic shock. On the downside, invasive treatment and accompanying antithrombotic therapies are associated with an increased bleeding risk. Prospective data assessing the incidence, severity, risk factors, and prognostic implication of bleeding in patients with cardiogenic shock are scarce. METHODS: As a pre-defined subanalysis of the CULPRIT-SHOCK (PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock) randomized trial, we examined distribution of bleeding events in 684 patients with infarct-related cardiogenic shock and compared patients with any bleeding to those without. RESULTS: A total of 21.5% patients experienced at least 1 bleeding event until 30 days after randomization. The vast majority of bleeding (57%) occurred within the first 2 days of hospitalization. Patients with bleeding had prolonged catecholamine treatment and mechanical ventilation and there was a significant association with sepsis, peripheral ischemic complications, new atrial fibrillation, and ventricular fibrillation. In multivariable analysis, bleeding was associated with a significantly higher mortality (hazard ratio: 2.11; 95% confidence interval: 1.63 to 2.75; p < 0.0001). Treatment with active mechanical support by extracorporeal membrane oxygenation or Impella emerged as the major risk factor for bleeding. CONCLUSIONS: Risk of bleeding in infarct-related cardiogenic shock is high and associated with increased mortality.
Authors: Enzo Lüsebrink; Antonia Kellnar; Clemens Scherer; Kathrin Krieg; Mathias Orban; Tobias Petzold; Sven Peterss; Stefan Kääb; Stefan Brunner; Daniel Braun; Christian Hagl; Jörg Hausleiter; Steffen Massberg; Martin Orban Journal: Clin Res Cardiol Date: 2021-05-09 Impact factor: 5.460
Authors: Martin Orban; Jan Kleeberger; Holger Thiele; Taoufik Ouarrak; Anne Freund; Hans-Josef Feistritzer; Georg Fuernau; Tobias Geisler; Kurt Huber; Dariusz Dudek; Marko Noc; Gilles Montalescot; Alexander Neumer; Paul Haller; Peter Clemmensen; Uwe Zeymer; Steffen Desch; Steffen Massberg; Steffen Schneider; Jörg Hausleiter Journal: Clin Res Cardiol Date: 2021-05-17 Impact factor: 5.460