Jacob C Jentzer1,2, Benedikt Schrage3,4, David R Holmes1, Salim Dabboura3,4, Nandan S Anavekar1, Paulus Kirchhof3,4, Gregory W Barsness1, Stefan Blankenberg3,4, Malcolm R Bell1, Dirk Westermann3,4. 1. Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. 2. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA. 3. Department of Interventional and General Cardiology, University Heart Centre Hamburg, Hamburg, Germany. 4. German Centre for Cardiovascular Research (DZHK), University Heart Centre Hamburg, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany.
Abstract
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. Published on behalf of the European Society of Cardiology. All rights reserved.
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. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Jacob C Jentzer; Sean van Diepen; Steven M Hollenberg; Patrick R Lawler; Kianoush B Kashani Journal: Mayo Clin Proc Innov Qual Outcomes Date: 2021-12-23
Authors: María Isabel Barrionuevo-Sánchez; Albert Ariza-Solé; Daniel Ortiz-Berbel; José González-Costello; Joan Antoni Gómez-Hospital; Victòria Lorente; Oriol Alegre; Isaac Llaó; José Carlos Sánchez-Salado; Josep Gómez-Lara; Arnau Blasco-Lucas; Josep Comin-Colet Journal: J Geriatr Cardiol Date: 2022-02-28 Impact factor: 3.327
Authors: Jacob C Jentzer; Benedikt Schrage; Parag C Patel; Kianoush B Kashani; Gregory W Barsness; David R Holmes; Stefan Blankenberg; Paulus Kirchhof; Dirk Westermann Journal: J Am Heart Assoc Date: 2022-05-02 Impact factor: 6.106